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Peripheral nerve blocks for analgesia following cesarean delivery A narrative review. | LitMetric

AI Article Synopsis

  • Spinal and epidural blocks are typically used for pain relief during and after cesarean sections, with intrathecal morphine being the traditional gold standard.
  • Recent studies have explored peripheral nerve blocks (PNBs) as alternative methods for postoperative analgesia, often in combination with ITM.
  • The combination of ilio-inguinal nerve and anterior transversus abdominis plane blocks along with ITM has shown to be the most effective strategy, reducing pain levels significantly compared to ITM alone, while PNBs are preferred for their opioid-sparing effects and fewer side effects like hypotension and bradycardia.

Article Abstract

Spinal and epidural blocks are commonly employed for pain relief during and following cesarean section. Intrathecal morphine (ITM) has been the gold standard for the same for many years. In recent times, many peripheral nerve blocks (PNBs) have been tried for postoperative analgesia following cesarean delivery (PACD). This article has reviewed the common PNBs used for PACD. The role of PNBs along with ITM has been studied and the current best strategy for PACD has also been explored. Currently, Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine have been found to be the most effective strategy, providing lower rest pain at 6 hours as compared to ITM alone. In patients not receiving intrathecal morphine, recommended PNBs are lateral transversus abdominis plane block, single shot local anesthetic wound infiltration, or continuous wound infiltration with catheter below rectus fascia. PNBs are recommended for PACD. They have an opioid-sparing effect and are devoid of adverse effects associated with central neuraxial blocks such as hypotension, bradycardia, and urine retention. However, caution must be observed with PNBs for possible local anesthetic toxicity due to the large volumes of drug required.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196051PMC
http://dx.doi.org/10.4103/joacp.joacp_204_22DOI Listing

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