Postoperative Pain After Caesarian Section

Impact of Guideline Recommendations for Post-caesarean Analgesia on Pain, Nausea and Pruritus

To examine if perioperative pain/nausea/pruritus is altered when current standard analgesia for caesarian section (CS) is replaced with new guideline recommended analgesia.

Control group (current analgesia, elective CS) is compared to current analgesia for emergency CS, and guideline recommended analgesia.

Current analgesia for CS:

Spinal hyperbaric bupivacaine 5 mg/ml, 9-11 mg. Spinal fentanyl 10-15 ug. Postoperative: Paracetamol 1g x 4, ibuprofen 400 mg x 4 po, oxycodone 10 mg (<70 kg) or 20 mg (>70 kg) x 2 po, additional oxycodone 2,5 mg iv/5 mg po when needed.

Guideline recommended analgesia for CS:

Spinal hyperbaric bupivacaine 5 mg/ml, 9-11 mg. Spinal fentanyl 12,5 ug. Spinal morphine 0,05 mg. After delivery of baby: Dexamethasone 8 mg iv, paracetamol 1g iv, parecoxib 40 mg iv.

Postoperative: Paracetamol 1g x 4, ibuprofen 600 mg x 4 po, oxycodone 2,5 mg iv/5 mg po when needed.

Inclusion Criteria:

- Healthy parturient, term pregnancy, undergoing caesarian section

Exclusion Criteria:

• Patient refusal
• Maternal heart or lung disease (not including mild asthma)
• Known or suspected obstructive sleep apnoea syndrome
• Pre-eclampsia
• Body mass index > 40
• Indulin-dependent diabetes mellitus
• Contraindications to ibuprofen, dexamethasone or morphine
• Chronic pain
• Neurological disease
• Drug abuse
• Age < 18 years
• American Society of Anesthesiologists (ASA) 3
• Patients receiving other forms of anaesthesia (epidural or general)