How are pain relievers after cesarean section used?

This is an automatically translated article.

The article was professionally consulted by Pharmacist Nguyen Thi Linh - Vinmec Danang International General Hospital.
Painkillers after cesarean section help mothers reduce the pain caused by cesarean section, but it is necessary to ensure that pain relievers after cesarean section are less excreted in breast milk and have little effect on the newborn.

1. How to choose pain reliever after cesarean section?

During the first 3 months after a cesarean section, the mother will face more abdominal pain than the mother giving birth vaginally. For about 6 months after a cesarean section, up to 60% of mothers experience pain in the wound. In addition to the pain of the incision, the mother also has to deal with back pain and pain in the perineum.
The choice of pain reliever after cesarean section for the mother is based on the following factors:
Safe for mother and breastfed baby. Ensure that the mother can walk, exercise gently and stay awake so that she can take care of the baby. It depends on the mother's medical condition, medical history, and the severity of the pain.

2. How are pain relievers after cesarean section used?

2.1 Guidelines for the use of analgesics after cesarean section according to the Oxford Handbook of Practical Drug Therapy - Duncan Richards and J. K. Aronson (Oxford University Press 2005) Based on the severity of pain, the following types of wound analgesia are used:
Mild pain: paracetamol Mild - moderate pain: paracetamol plus mild opioid (codeine, dihydrocodein) Moderate - severe pain: paracetamol, NSAID and mild opioid (codeine, dihydrocodein) Severe pain: NSAID and opioid Very severe pain: NSAID and morphine (depending on the patient) Extreme pain: opioid epidural and local anesthesia

2.2 Guidelines for the use of analgesics after cesarean section of the National Institute for Health and Clinical Excellence (NICE) During and after surgery: intrathecal injection of diamorphine 0.3 - 0.4 m, or alternatively by epidural anesthesia also with diamorphine but at a dose of 2.5 - 5.0 mg, which helps to reduce the additional use of other analgesics after cesarean section. Treatment with opioid pain medications varies from mother to mother, depending on the mother's condition. In the absence of contraindications, non-steroidal anti-inflammatory drugs (NSAIDs) should be used adjunctively because they may reduce opioid intake. Depending on the severity of the pain, the following analgesics are recommended: co-codamol (codeine phosphate and paracetamol) with ibuprofen for severe pain; co-codamol for moderate pain; Paracetamol is used for mild pain.

2.3 Guidelines for the use of analgesics after cesarean section according to St Michael's Hospital, Bristol, UK After surgery: inject morphine 1mg into a device containing a pump attached to an infusion line to deliver the drug into the body. through a vein in the mother's upper or lower extremities. Concluding surgery: insert diclofenac 100mg (contraindicated for mothers with preeclampsia or hemorrhoids). First 3 days after surgery: paracetamol and diclofenac. 2.4 Post-cesarean section analgesics used 2.4.1 Post-cesarean section analgesics containing opioid Codeine: This is an oral pain reliever. Dosage is Codeine 60mg every 4-6 hours, used in 24 hours, maximum 240mg. The most common side effect of the drug is nausea. Oxycodone: This is an oral pain reliever. Dosage is Oxycodone 50mg every 4 hours, used for 24 hours, up to a maximum of 30mg. Morphine: This is a pain reliever after cesarean section that is injected into the nerve shaft, which has a selective anesthetic effect on the spine. If injected into the spine, it takes about 15 minutes to take effect, if it is an epidural, it takes about 30 minutes. Hydromorphone: A shorter-acting drug than morphine sulfate. Levorphanol: This postpartum pain reliever is well absorbed when taken orally and has a longer duration of action than morphine sulfate. Methadone: The drug has a side effect of causing prolonged drowsiness due to its slow half-life. Meperidine: The drug is poorly absorbed when taken orally, in addition, normeperidine is also metabolized to be toxic. Fentanyl: This is an injection or patch.

2.4.2 Non-opioid analgesics after cesarean section
Acetylsalicylic acid: This is a drug made in the form of enteric-soluble tablets. Acetaminophen (paracetamol): The drug has analgesic effect but does not have anti-inflammatory properties and causes few side effects. Maximum dose 4g/day. Ibuprofen: This pain reliever after cesarean section is taken orally at a dose of 400mg in the first 72 hours after surgery, taken every 4-6 hours. Naproxen: Long-acting drug due to its slow half-life. Ketoprolac: This is an injection (intramuscular) that is used to get rid of other pain relievers. Trisalicylate: This drug has less effect on the digestive system and platelets than aspirin. Indomethacin: This drug works on the digestive system. Tramadol: The drug has a strong analgesic effect and rarely causes respiratory depression as a side effect.

3. Some measures to help breastfeeding mothers reduce pain after cesarean section

In addition to being indicated for the use of pain relievers mentioned above, some measures to note the following also contribute to helping mothers reduce pain after cesarean section:
Lie on your side while sleeping and resting: To quickly recover the body For about 2 months after giving birth, the mother should sleep on her side, and rest, can use an extra pillow to prop her back. Especially right after giving birth, lying on your side while breastfeeding will help the mother reduce the pain caused by the contraction of the uterus, and reduce the feeling of nausea and headaches. During this period, the mother needs to spend a lot of time resting, when lying down, she should also lie on her side to create a sense of comfort and limit the impact of the incision. Gentle exercise: Gentle exercise after surgery helps blood vessels circulate, avoids hematoma, and helps the body quickly recover, and reduces pain after cesarean section. Do not exercise too much: After a cesarean section for about 2 months, the mother should not exercise too much or too hard, because at this time the muscles in the abdomen are still weak. Vigorous exercise or overwork after cesarean section can affect the incision, causing dangerous complications.

Painkillers after cesarean section are used depending on the severity of the pain and the mother's health condition. However, most of these drugs do not affect infants and mothers are advised to breastfeed before taking them.
Vinmec International General Hospital applies the painless delivery method with a team of professional anesthesiologists and resuscitators, so pregnant women will no longer have to struggle with pain. For pregnant women who have had a caesarean section, they will be numbed by an ultrasound machine to treat pain after surgery. The results of the most recent evaluation of pain relief showed that: All pregnant women who gave birth by cesarean section did not have to use morphine, and postpartum pain when moving and living was almost no longer recorded.

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