Local anesthetic during C-section curbs later pain

Two pain-relieving techniques done during cesarean section may reduce women's need for narcotic painkillers afterward, a research review finds.

After having a C-section, women are typically given a combination of painkillers, including opiate drugs such as morphine. But opioids come with side effects like forgetfulness and sedation, and can be transferred to breast milk, leading to drowsiness in the infant.

The new review, of 20 clinical trials, found that adding either of two interventions to standard anesthesia during C-section reduced women's pain and need for opiates after giving birth.

One intervention is known as an abdominal nerve block, in which a nerve- dulling drug is injected into the abdomen before the C-section incision is made. The other is called wound infiltration, in which a surgeon irrigates the surgical wound with a solution containing painkillers such as ibuprofen.

Based on the review findings, women planning on having a C-section can ask their doctors about having either option, lead researcher Dr. Anthony A. Bamigboye, of the University of Witwatersrand in South Africa, told Reuters Health.

The findings are published in the Cochrane Database of Systematic Reviews, part of the Cochrane Library.

The time immediately after birth is an important period of mother- infant bonding, Bamigboye explained, so new mothers should ideally have the least amount of pain possible and be able to start breastfeeding right away.

"Any intervention that can make this goal a reality can not be overstated," Bamigboye said.

None of the trials in the review tested whether abdominal nerve block or wound infiltration affected women's risk of chronic pelvic pain in the long term. Future studies should look at that question, as well as the costs of local anesthetics, the researchers say.

SOURCE: Cochrane Database of Systematic Reviews, online July 8, 2009.