Postoperative pain management for caesarean section in Denmark: A survey of current clinical practice.

Abstract

Background: Postoperative pain relief has a decisive role in recovery and early mother-child bonding. Recent Danish surveys show that 45%-66% of patients experience severe pain following caesarean section. The aim of this survey is to review the standard practice for postoperative pain management currently provided at Danish delivery centres.

Method: A questionnaire of 16 questions was sent to the anaesthetist team in charge of obstetric anaesthesia, aiming to explore local standard care for caesarean section and pain management at the postoperative care unit and at the ward. The answers were received between April 2023 and November 2023.

Results: All Danish centres provided answers (22/22). Only one centre used intrathecal morphine (dose 40 μg) for postoperative pain management combined with a lipophilic opioid and hyperbaric bupivacaine. The same centre used epidural morphine. The rest relied on oral opioids in addition to NSAID and paracetamol. One centre used opioid-free spinal anaesthesia as standard. Five (23%) centres used extended-release morphine for postoperative treatment. No centres used patient-controlled intravenous opioid analgesia. A total of 16 (73%) centres used truncal nerve blocks for 'rescue' treatment, but only 2 (9%) for prophylaxis. Paracetamol treatment was started before or during surgery in 9 (41%) centres. All centres used NSAID as part of the treatment, but at least 7 (32%) centres had 'perioperative blood loss of more than 1-1.5 L' as a contraindication. Large doses of fentanyl or sufentanil were used for caesarean section under general anaesthesia, and 2 (9%) centres used intravenous morphine before extubation. Difficult cases of severe postoperative pain were solved ad hoc between anaesthetists and obstetricians in all centres.

Conclusion: Most Danish delivery centres relied on oral morphine in addition to NSAIDs and paracetamol for postoperative pain management following caesarean section. Use of truncal nerve blocks, wound infiltration and extended-release morphine showed many differences between centres. Intrathecal morphine was hardly used despite international recommendations due to the concern of side effects. A national research initiative (www.cepra.nu) will facilitate the evaluation of evidence and treatment options following caesarean section in Denmark.

Editorial comment: Using a survey to examine the standard practice for postoperative pain management after caesarean sections in Danish delivery centres, 22 anaesthesia teams responded, reporting the most common postoperative pain management as oral morphine in addition to NSAID and paracetamol. The responses presented variation in local obstetric anaesthetist standard practice. Reporting of intrathecal morphine for post-op analgesia was also noted.