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Abstract
Background and Aims Caesarean section (CS) is the most performed operation worldwide. In the UK 1 in 4 women give birth by CS. Poorly managed acute pain following CS can complicate recovery, new-born care, prolong hospital stay and risk the development of chronic post-surgical pain. The PROSPECT working group advises regional techniques post-operatively. A recent update highlights ilioinguinal-iliohypogastric blocks in reducing postoperative opioid- consumption and advocates erector spinae plane blocks following CS, as an alternative to neuraxial opioids. We investigated the current practice in our trust to ascertain what pain relief is given to women following such surgery.
Methods A survey was sent to all anaesthetist in our department. Data was collected anonymously with reference to their current practice. A literature search using Medline and Embase to explore the efficacy of regional blocks post CS provided a framework for best practice.
Results 39 relevant studies investigating fascial plane or peripheral nerve blocks for post CS pain were considered. Literature was unified in the beneficial outcomes of regional blocks in this patient group particularly in absence of neuraxial opioids, however 42% of anaesthetists surveyed at our trust never provide them.
Showing anaesthetists surveyed, who routinely work in Maternity at Bucks NHS Trust and prevalence of regional blocks provided post- operatively
Snapshot of ‘which block’ is provided in the instances of regional analgesia being offered to this cohort of patients in maternity
Illustrates opinions of Anaesthetist surveyed regarding most suitable scenario to offer regional analgesia post CS, if at all
Conclusions Interest in regional anaesthesia is growing following the adoption of ‘Plan A blocks’ in the new curriculum. However, the list does not include a block for a Pfannenstiel incisions. Our results highlight a space for regional analgesia following CS, though further investigation regarding implementation is required. An enhanced recovery programme following CS including regional anaesthesia to compliment multi-modal analgesia might improve the daily lives of many women.