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C-section pain management

Their first embrace shaped by love, not pain

For anesthesiologists, C-section pain management after cesarean delivery is more than postoperative pain care. It supports early recovery, maternal wellbeing and the first precious moments between mother and baby.

Clinical Insights: Persistent Pain After Cesarean Section

Stay informed with evidence-based insights on persistent post-cesarean pain. Watch out the infosheet for key data, risk factors, and clinical implications.

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Clinical relevance

Why C-section pain management matters

C-section is one of the most frequently performed surgical procedures worldwide.¹ Yet pain after C-section can be underestimated. Structured, guideline-aligned pain management helps support recovery, mobility and maternal-neonatal wellbeing.

“Effective pain control relies on a scheduled multimodal approach - combining systemic analgesia with regional anesthesia techniques such as abdominal wall blocks or wound infiltration to reduce opioid needs and optimize recovery.”

Prof. Dr. Marc Van de Velde, MD, PhD, EDRA, FESAIC

approx

0%

births globally are by cesarean delivery²
ranked

0th

among 179 procedures for Day-1 pain³
approx

0%

develop chronic post surgical pain (CPSP) at 3 months⁴

The impact of pain and the critical first

24 hours

After C-section, pain is more than a score. It may affect when a mother can sit up, walk, breathe deeply, sleep, breastfeed and hold her newborn. Effective postoperative pain control supports recovery from OR to home. The first 24 hours are critical: Suboptimal pain control strongly predicts chronic postsurgical pain (CPSP) at three months. A clear plan should cover pain at rest and movement, multimodal analgesia, monitoring and rescue options.

Guideline-aligned therapy pathway

PROSPECT recommends practical approaches to pain management for common procedures such as elective C-section.

Regional Anesthesia

Single-shot spinal anesthesia is commonly used for C-section; epidural and CSE can also be used in selected clinical contexts.⁵

Basic Analgesia

Scheduled multimodal analgesia combines systemic analgesics and keep contribute to reduce pain scores.⁶

Local technique

If no neuraxial opioids are used, consider regional anesthesia techniques such as TAP, QL, ESP or II-IH blocks, or wound infiltration.⁶

Surgical factors

Surgical factors: procedure-related contributors to postoperative pain.⁶

Rescue strategy

Consider analgesic rescue strategy if needed.⁶

Cesarean section is one of the most frequently performed surgical procedures worldwide and is associated with high postoperative pain intensity. Adequate pain control helps facilitate early mobilization, recovery and maternal-neonatal outcomes.

Insufficient pain control can negatively impact functional recovery and maternal wellbeing and may contribute to the development of chronic post surgical pain.

Approximately 14.6% of patients develop chronic post surgical pain (CPSP) three months after cesarean delivery. This may significantly affect function, sleep, mood and quality of life.

Current recommendations emphasize a multimodal, procedure-specific approach across the perioperative continuum, including structured postoperative analgesia and appropriate rescue strategies.

Current evidence indicates no additional benefit from combining multiple block techniques or combining blocks with wound infiltration. Technique selection should be individualized.

PROSPECT Video

Watch now to explore the practical application of the latest PROSPECT elective caesarean section guidelines in clinical practice.

Pencan®

Spinal needle with pencil-point bevel type for intrathecal injections and diagnostic lumbar puncture.

hands of an anesthesiologist threading an epidural catheter through the epidural needle placed in a patient back

Perifix^® Sets

Sets for continous epidural anesthesia.

gloved hands of an anesthesiologist introducing a spinal needle inside an epidural needle placed in a patients back through a circular access site in a blue sterile surgical drape

Espocan®

CSE sets for combined spinal-epidural techniques

gloves hand of an anesthesiologist handling a peripheral nerve block needle by the grip while holding an ultrasound transducer with the other hand

Stimuplex® Ultra 360

PNB needle for regional anesthesia techniques such as abdominal wall blocks.

gloved hands holding a half full syringe connected to a portable soft balloon pump for filling

Easypump® II

elastomeric pump for continuous infusion.

Clear flexible thin catheter forming loops featuring measurement markings and small fluid droplets exiting from multiholes located at one end

Cimpax C-CAT®

catheter option for wound infiltration.

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References

1. Betran AP, Ye J, Moller A, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health. 2021;6:e005671. https://gh.bmj.com/content/bmjgh/6/6/e005671.full.pdf

2. Zaigham M, Varallo J, Thangaratinam S, Nicholson W, Visser GH. Global disparities in caesarean section rates: why indication-based metrics are needed. PLOS Glob Public Health. 2024;4(2):e0002877. https://journals.plos.org/globalpublichealth/articleid=10.1371/journal.pgph.000877

3. Gerbershagen HJ, Aduckathil S, van Wijck AJM, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013 Apr;118(4):934-44. https://journals.lww.com/anesthesiology/fulltext/2013/04000/pain_intensity_on_the_first_day_after_surgery__a.26.aspx

4. Espinós Ramírez C, Castellví Obiols P, Martínez-Rodríguez D, Raynard M, Viscasillas Draper B, Masgoret P, et al. Acute postoperative pain after caesarean section, intensity and management: a cohort multicentre study. Eur J Pain. 2026 Jan;30(1):e70183. https://onlinelibrary.wiley.com/doi/10.1002/ejp.70183 msockid=129be3af714669fa0a53f6bd70466898

5. Roofthooft E, Rawal N, Van de Velde M. Current status of the combined spinal-epidural technique in obstetrics and surgery. Best Pract Res Clin Anaesthesiol. 2023 Jun;37(2):189-198. https://www.binasss.sa.cr/bibliotecas/bhm/jun23/57.pdf

6. Crowe G, Atterton B, Roofthooft E, Joshi GP, Rawal N, Wu C, et al. Pain management after elective caesarean section under neuraxial anaesthesia: an updated systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Anaesthesia. 2026;81:819-839. https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70141

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Their first embrace shaped by love, not pain