Caesarean section under general anaesthesia

The most commonly used drugs in this situation are intraoperative intravenous opioids (e.g. morphine 10-20mg or diamorphine 5-10mg), an NSAID (e.g. diclofenac 100 mg given rectally at the end of surgery) and either intramuscular or patient-controlled intravenous opioids postoperatively. Regular paracetamol and NSAIDs act synergistically with both strong and weak opioids and may be given orally or rectally. Specific consent should be sought before administering rectal drugs, and this may preclude the immediate postoperative use of these drugs in the emergency situation.

NSAIDs are contraindicated in women with severe pre-eclampsia because of their effect on platelet function and should also be used with caution in asthmatics. The potentially adverse effect of NSAIDs on renal function should be considered in women who are hypovolaemic and in those who have compromised renal function.

Bilateral ilioinguinal blocks have been shown to improve postoperative pain control, and should be considered for all cases under general anaesthesia. Rectus sheath blocks may also be used, although this is more difficult immediately after Caesarean section than in elective gynaecological surgery.

In the emergency situation there may be an epidural catheter in place but insufficient time to extend a block for anaesthesia, but this does not preclude use of the catheter for postoperative analgesia using epidural opioids.

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