Impact of an anaesthetist-led acute pain service for caesarean delivery as part of an enhanced recovery program: a retrospective before-and-after single-centre cohort study (2021-2023).

BACKGROUND

Postoperative pain after caesarean delivery is frequently moderate to severe, and insufficient analgesia may lead to chronic pain, prolonged opioid use, delayed functional recovery, and postpartum psychological distress. Structured postoperative pain management programmes may improve outcomes; however, they are rarely implemented in obstetric practice. This study evaluated the impact of an anaesthesialed acute pain service designed to standardise multimodal postoperative analgesia and early recovery processes.

METHODS

We conducted a single-centre retrospective before-after cohort study at a tertiary care centre, including women who underwent caesarean delivery under neuraxial anaesthesia. We excluded women receiving general anaesthesia or with missing postoperative outcomes. The primary outcome was the maximum pain score on an 11- point numerical rating scale within 24 h. Secondary outcomes included the proportion of women with moderate-to-severe pain, postoperative opioid use, time to first oral fluid intake, and postoperative adverse effects.

RESULTS

A total of 955 women were analysed. After implementation of the anaesthesia-led service, maximum 24-hour pain scores were significantly lower (3.4 ± 1.9 vs. 5.0 ± 2.0, P < 0.001), and fewer women experienced moderate-to-severe pain (42% vs. 74%, P < 0.001). Time to first oral fluid intake was shorter (233 ± 162 vs. 441 ± 142 min, P < 0.001). The proportion receiving postoperative systemic opioids increased slightly (18.7% vs. 13.1%, P = 0.02), but total morphine-equivalent dose remained similar (0.65 ± 1.58 vs. 0.78 ± 2.25 mg, P = 0.29).

CONCLUSION

An anaesthesia-led acute pain service significantly improved postoperative pain and enabled earlier oral intake after caesarean delivery without increasing complications. This structured approach may support enhanced recovery pathways in obstetric.