Post-caesarean delivery analgesia in resource-limited settings: a narrative review

• Published in: International journal of obstetric anesthesia 2019-11, Vol.40, p.119-127
• Main Authors: Bishop, D.G., Gibbs, M.W., Dyer, R.A.
• Format: Article
• Language: English
• Subjects: Analgesia, Obstetrical - methods; Cesarean Section; Developing Countries; Female; Humans; Low and middle-income countries; Pain, Postoperative - drug therapy; Post-caesarean analgesia; Poverty; Pregnancy; Resource-limited settings
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2019.05.009

•Post-caesarean analgesia in resource-limited settings is a significant challenge.•Lack of education, staffing and monitoring are barriers to effective pain control.•Solutions are possible using multimodal, affordable and accessible medications.•Education and training of healthcare workers are vital. Post-caesarean pain is an important and often neglected outcome. It causes suffering, affects breastfeeding and is associated with postpartum depression and the development of chronic pain syndromes. Pain control is often difficult even in resource-rich environments; it is likely far worse in resource-limited settings, where emphasis is on reducing the high maternal mortality rate. Lack of adequate staffing, education, and postoperative monitoring severely limit the options in resource-limited settings. Resource-limited settings are further compromised by limited access to essential analgesic drugs and equipment for their administration. Solutions using affordable and accessible medications as part of a multimodal analgesic strategy are possible, supplemented by education and training programmes. More research is required, both to establish current practice and to test methods for improving maternal pain control. While government involvement is necessary to improve infrastructure and resources in individual countries, other solutions should also be sought, empowering local institutions and harnessing individual cultural characteristics.