Anesthesiologists push to improve pain control during caesarean delivery

Editor's Note

A letter to the editor published April 10 in Anesthesiology, the official publication of the American Society of Anesthesiologists (ASA), calls attention to an official statement outlining best practices for ensuring all moms-to-be receive adequate pain management during planned or unexpected C-sections.

The best practices are outlined in an official statement originally published on October 23. This communication advises all practitioners “on the pervasive problem of failure to achieve pain-free cesarean delivery,” writes Mark Zakowski, M.D., FASA, chair of ASA’s Committee on Obstetric Anesthesia a lead developer of the statement.

“With 1.3 million cesarean deliveries annually and a 15% pain rate, about 195,000 parturients experience pain during cesarean delivery in the United States each year,” Zakowski writes. “We can and must do better!”

 The ASA recommendations are organized into seven topics:

1. Preoperative assessment (such as conversing with the patient to facilitate shared decision-making and understand risks and potential complications).
2. Minimizing risk of inadequate regional anesthesia (applying best obstetric anesthesia practices to reduce this risk and prevent conversion to even risker general anesthesia).
3. Supplementation of inadequate regional anesthesia (usually in the form of neuraxial and systemic adjuvant medication and adequate surgical anesthesia).
4. Conversion to general anesthesia (diagnosing the need for and managing this clinical event)
5. Conduct of general anesthesia (topics such as preparation of medication, equipment, and assistance with airway management).
6. Follow-up and referral
7. Quality improvement

The full statement offers deeper explanations of each topic as well as best practices for ensuring positive outcomes.