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Postcaesarean section analgesia: are opioids still required?

Schyns-van den Berg, Alexandra M.J.V.a; Huisjes, Anjokeb; Stolker, Robert Janc

Current Opinion in Anaesthesiology: June 2015 - Volume 28 - Issue 3 - p 267–274
doi: 10.1097/ACO.0000000000000195

Purpose of review The use of opioids for postoperative pain relief after caesarean section is widely spread. Because of unwanted well known side-effects, alternative drugs and methods of pain relief have been introduced, either in addition to or instead of opioids. Can postcaesarean analgesia be achieved these days without opioids?

Recent findings Most components of multimodal postcaesarean analgesia have not been studied thoroughly during pregnancy and lactation, and not one or a combination of them has yet proven to be superior to opioids.

New applications of local anaesthetics and other drugs, new combinations of existing drugs and new developments in predicting an individual's response to pain provide tools to minimize opioid use for postoperative pain relief in caesarean section.

Summary The dependency on opioids for postcaesarean analgesia is diminishing, but in order to develop effective, well tolerated alternatives, more research is needed.

In the meantime, opioids are here to stay.

aDepartment of Anesthesiology, Albert Schweitzer Hospital, Dordrecht.

bDepartment of Obstetrics and Gynaecology, Gelre Hospitals, Apeldoorn.

cDepartment of Anesthesiology, Erasmus MC: University Medical Center, Rotterdam, The Netherlands

Correspondence to Alexandra M.J.V. Schyns-van den Berg, Albert Schweitzer Ziekenhuis, Postbus 444, 3300 AK Dordrecht, The Netherlands. Tel: +31786542589; fax: +31786523332; e-mail:

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