Regional Anaesthesia
Single-shot spinal anaesthesia is commonly used for C-section; epidural and CSE can also be used in selected clinical contexts.5
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C-Section Pain Management
For anaesthetists, C-section pain management after caesarean delivery is more than postoperative pain care. It supports early recovery, maternal wellbeing and the first precious moments between mother and baby.
“Effective pain control relies on a scheduled multimodal approach - combining systemic analgesia with regional anaesthesia techniques, such as abdominal wall blocks or wound infiltration, to reduce opioid needs and optimise recovery.”
approximately
0%
births globally are by caesarean delivery2
ranked
0th
among 179 procedures for Day-1 pain3
approximately
0%
develop chronic post surgical pain (CPSP) at 3 months4
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.10 Effective postoperative pain control supports recovery from OR to home (Neall, Bampoe and Sultan, 2022). The first 24 hours are critical: suboptimal pain control strongly predicts chronic postsurgical pain (CPSP) at three months.9 A clear pain management plan should cover pain at rest and movement, multimodal analgesia, monitoring and rescue options.11
PROSPECT recommends practical approaches to pain management for common procedures such as elective C-section.
Single-shot spinal anaesthesia is commonly used for C-section; epidural and CSE can also be used in selected clinical contexts.5
Scheduled multimodal analgesia combines systemic analgesics and can contribute to reducing pain scores.6
If no neuraxial opioids are used, consider regional anaesthesia techniques such as TAP, QL, ESP or II-IH blocks, or wound infiltration.6
Surgical factors: procedure-related contributors to postoperative pain.6
Consider analgesic rescue strategy if needed.6
Caesarean section is one of the most frequently performed surgical procedures worldwide and is associated with high postoperative pain intensity. Adequate pain control can help to facilitate early mobilisation, 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 25.5% of women reported chronic postsurgical pain 3 months after caesarean section. This may significantly affect function, sleep, mood and quality of life.7
Current recommendations emphasise a multimodal, procedure-specific approach across the perioperative continuum, including structured postoperative analgesia and appropriate rescue strategies.8
Current evidence indicates no additional benefit from combining multiple block techniques or combining blocks with wound infiltration. Technique selection should be individualised.8
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
7. Borges NC, de Deus JM, Guimarães RA, Conde DM, Bachion MM, de Moura LA, et al. The incidence of chronic pain following Cesarean section and associated risk factors: A cohort of women followed up for three months. PLoS One. 2020;15(9):e0238634. doi:10.1371/journal.pone.0238634.
8. Roofthooft E, Joshi GP, Rawal N, Van de Velde M, PROSPECT Working Group. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(5):665-680. doi:10.1111/anae.15339.
9. Eisenach, J.C., Pan, P.H., Smiley, R., Lavand'homme, P., Landau, R. and Houle, T.T. (2008) 'Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression', Pain, 140(1), pp. 87-94. doi:10.1016/j.pain.2008.07.011.
10. Neall, G., Bampoe, S. and Sultan, P. (2022) 'Analgesia for Caesarean section', BJA Education, 22(5), pp. 197-203.
11. Roofthooft, E., Joshi, G.P., Rawal, N. and Van de Velde, M. (2021) 'PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations', Anaesthesia, 76(5), pp. 665-680. doi:10.1111/anae.15339.
