Postcaesarean section analgesia: are opioids still required?

PURPOSE OF REVIEW: The use of opioids for postoperative pain relief after caesarean section is widely spread. Because of unwanted well known side-effects, alternative drugs and methods of pain relief have been introduced, either in addition to or instead of opioids. Can postcaesarean analgesia be achieved these days without opioids?

RECENT FINDINGS: Most components of multimodal postcaesarean analgesia have not been studied thoroughly during pregnancy and lactation, and not one or a combination of them has yet proven to be superior to opioids.New applications of local anaesthetics and other drugs, new combinations of existing drugs and new developments in predicting an individual's response to pain provide tools to minimize opioid use for postoperative pain relief in caesarean section.

SUMMARY: The dependency on opioids for postcaesarean analgesia is diminishing, but in order to develop effective, well tolerated alternatives, more research is needed.In the meantime, opioids are here to stay.