Pain Relief After Cesarean Section

If you have general anesthesia, your obstetrician will prescribe your pain control. This is typically through an intravenous (IV) catheter. If you have regional anesthesia, the OB anesthesia team will prescribe your pain control which will be one of several options depending on your individual situation. In most instances, a narcotic pain reliever (given near your spine) will be combined with anti-inflammatory drugs given in an IV catheter and/or by mouth. You will wear an orange bracelet that identifies you as having neuraxial (around the spine) narcotics and an orange sign will be placed by your bed as well.

A Cesarean Section is a major abdominal operation and you should not expect to be pain-free afterwards. We talk about pain in the hospital using a 0-10 scale where 0 is no pain at all and 10 is the worst pain you can imagine. These faces can sometimes help you determine your pain level:

Wong Baker Pain Scale

The goal is for your pain score to be in the 0-4 range most of the time. When the nurses push on your belly you can expect your pain score to be higher than that range. The pain you experience will likely include cramping in your lower abdomen and back which is caused by your uterus contracting and shrinking down, a burning sensation over your incision, and a general soreness in the muscles of your abdomen. If your pain is not well-controlled in spite of your medications, let your nurse know. She will try to make things better and call the anesthesia physicians if necessary.

All narcotic pain relievers can have side effects which include itching, nausea, difficulty urinating and feeling strange or sleepy. There are medications ordered to help with the side effects of itching and nausea so ask your nurse if you need them. If you are having difficulty urinating or are feeling strange or very sleepy, let your nurse know.

Epidural Demerol (Meperidine)

Demerol is a narcotic pain reliever that is given through an epidural catheter if you had epidural or combined spinal-epidural (CSE) anesthesia. That means it will control pain but not make you numb. This is the most common form of pain relief that we offer. The Demerol is given as patient-controlled epidural analgesia (PCEA). This means that you will have a constant infusion of medication going in and you will have a button that you can push to give yourself extra doses of medication if you need them. When you push the button you should hear a beeping noise. If you do not, have your nurse check your pump to make sure that it is working properly. You should start to feel improvement in your pain within 10-15 minutes of pushing the button and this should last 1-4 hours. It is not expected that you should have to push your button very often but the button allows you to individualize your pain medicine so that you can get as much or as little as you need. The pump will allow you to get a second dose after 15 minutes but has a limit to the number of doses you can get in an hour as a safety feature.

Demerol causes itching but to a lesser degree than the other pain relief options. Its use requires an epidural catheter to stay in place after surgery so it is not used if you had spinal anesthesia, a high fever, or will be placed on certain blood thinners soon after surgery. It is also not used in people with a history of seizures or in people with kidney dysfunction.

Epidural demerol is usually given for 36-48 hours. You can get up and walk around with it but you cannot leave the hospital (to smoke for instance) and you cannot shower while it is in place. You will be required to have an IV in place during that time.

Epidural Dilaudid

Dilaudid is used when a patient cannot get Demerol due to allergy or medical condition. It is also a narcotic pain reliever and it is given as a constant infusion through an epidural catheter. This medication does not come with a button but a nurse can give periodic additional doses if needed.

Just as with the Demerol, you can walk around but not leave the hospital with this medication and you will be required to keep an IV and not shower. This medication is usually given for 36-48 hours.

Epidural or Spinal Duramorph (Morphine)

Duramorph is another name for morphine. When given near the spine, it acts like a time-release drug providing pain relief for 18-24 hours in most patients. It is given as a single dose in spinals and in epidural catheters. It is associated with a good deal of itching and because it is a single dose approach, it does not allow the same flexibility in dosing that the infusion techniques do. With this medication, you will transition to oral narcotic pain medications as prescribed by your obstetrician 20 hours after the dose was given.