Local anaesthetic reduces need for painkillers post-Caesarean section

Giving a local anaesthetic during a Caesarean section helps manage pain after the operation and can reduce consumption of painkillers, according to Cochrane Researchers. The researchers recommend local anaesthetics as part of integrated pain management strategies for Caesarean section operations, provided that consideration is given to the cost.

"This review is particularly important in light of the growing number of women giving birth by Caesarean section," says lead researcher, Anthony Bamigboye, of the Department of Obstetrics and Gynaecology at the University of Witwatersrand in Johannesburg, South Africa. "Improved pain relief allows mothers to bond with their babies and begin breastfeeding more quickly."

Caesarean sections account for around a quarter of all births in the US, Canada and the UK. Local anaesthetics can be given, in addition to general or regional anaesthetics, to help manage pain during and after operations. The anaesthetic is either injected to block nerves in the abdominal wall or applied directly to the wound as an anaesthetic solution.

The researchers reviewed data from 20 studies that together involved 1,150 women who gave birth by Caesarean section in both developing and developed countries. They found that women treated with local anaesthetic as well as local or regional anaesthesia did not require as much morphine or other opioid drugs for pain relief after their operations. When non-steroidal anti-inflammatory drugs were also given, pain was reduced further.

One concern, however, is the additional cost of giving local anaesthetic. "None of the trials in this review addressed the cost implications of increasing use of local anaesthetic," says Bamigboye. "A cost benefit analysis is needed to find out whether increased expenditure on theatre time and local anaesthetic can be offset by reductions in postoperative painkillers."

Full bibliographic information: Bamigboye AA, Hofmeyr GJ. Local anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006954. DOI: 10.1002/14651858.CD006954.pub2.