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After C-Section: Less Pain and Faster Recovery without Opioids

By Mark Reisbig, MD October 05, 2021 Posted in: Maternity Care

No one wants to have pain. For a mom-to-be who is having a C-section, a smooth recovery with less pain can mean an easier transition to caring for their newborn.

At CHI Health Creighton University Medical Center – Bergan Mercy, a newer approach to pain control which relies less on opioids is helping new moms experience a quicker, easier recovery with less pain.

It’s easy to assume that opioids are necessary to relieve pain, because the conventional medications used for C-sections were based on opioids such as morphine, fentanyl and oxycodone.

Unfortunately, they can also cause sedation, constipation, nausea, vomiting, respiratory suppression, physical dependence, tolerance and hyperalgesia – meaning the sensation of pain actually increases as the medication wears off.

Opioids have also been linked to overdose and persistent use. For these reasons, there’s considerable effort in all areas of health care to move away from using opioids for pain relief.

A New Way to Ease Pain After C-Section

As part of an enhanced recovery after surgery protocol, a newer approach to pain control, called "multimodal analgesia," is being found to be effective at addressing pain from procedures such as C-sections.

Multimodal analgesia means using a number of different pain medications to address different aspects of how pain is perceived by the body and the brain. Some of these medications include:

  • Tylenol or acetaminophen
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen
  • Anesthetic agents, like ketamine and dextromethorphan

Benefits of This Pain Management Method

What this means for new moms is that only a minimal amount of morphine is used during the anesthetic for the procedure and Tylenol and ibuprofen are given around the clock for recovery. Most new moms do well with Tylenol and ibuprofen. If there’s still pain, there is an in-house pain specialist who can add other multimodal medications and possibly a small amount of opioid as needed.

It’s amazing to see the improvement in patients after surgery using multimodal analgesia. Before, with opioids, patients would be stuck in bed and would be groggy. Now they’re alert, they’re able to get up more easily and they’re not experiencing the negative side effects that can come with opioids.

We’re also not exposing new moms to medications that can be addicting – and we’re not sending these medications into the home where they can potentially be taken by someone other than whom they were prescribed.

How Do We Know this New Pain Relief Methods Work?

At CHI Health, we’ve been working on these practices for several years. It’s a multidisciplinary effort, including, anesthesiologists, surgeons, physicians, nurses, pharmacists and the entire perioperative team.

In a study, we tracked C-section patients before and after implementation of the multimodal analgesia strategies. Before implementation we were giving, on average, 90 morphine equivalents, compared to just 10 morphine equivalents after implementation. That’s a significant reduction in opioid use. The majority of our patients no longer receive any opioids after the procedure and do very well.

New moms also experienced decreased length of stay, increased pain control and improved recovery.

This data shows that for C-sections, multimodal analgesia is a viable alternative to using opioids exclusively for pain control. It’s part of an important shift away from opioid use for pain control that will likely continue in other areas of health care.

For more information about how CHI Health can help you visit CHI Heath Maternity Care.

Mark Reisbig, MD
Mark Reisbig, MD

Mark Reisbig, MD is an Anesthesiologist with CHI Health.

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