الفهرس 
Patient controlled intravenous analgesia (PCIA)Only 14 pages are availabe for public view
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Abstract
Inadequate postoperative pain control in obstetric patients can
significantly impact the well being of mothers and newborns in the
immediate postpartum period. Uncontrolled pain can impair functions
such as ambulation, dietary intake and respiration, and lead to possible
complications such as thromboembolism, ileus, atelectasis, and
pneumonia. In addition, inadequate pain control can also negatively
impact the normal development of infants by affecting nursing activities
such as breastfeeding.
In this work we aimed to discuss methods of post cesarean section
pain relief with special attention to new techniques like TAP block.
Starting with PCIA, its advantages are that it reduces the peaks and
valleys in blood drug concentrations and pain relief and in part by
bypassing the patient-nurse-injection loop. Pain relief with PCIA has
been shown to be superior to conventional IM opioids for pain relief in
women having had a cesarean delivery. The most significant limitations
to the use of PCIA in postpartum women relate to the device itself and
patient ability to use it correctly. The latter requires patient education and
implies that the patient will understand and follow through with
directions required to use demand mode PCIA effectively. The device
itself has an added cost over the use of conventionally administered
opioids. Another limitation of PCIA is that some devices may be
cumbersome and women may find it difficult to ambulate and care for
their infant. Nonetheless, PCIA has emerged as a popular modality for
post-cesarean delivery pain.
It has been almost 25 years since neuraxial opioids first underwent
rigorous clinical study for use in humans. Since that time, neuraxial
Summary
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techniques of providing post-cesarean delivery analgesia have become a
logical outgrowth of the increased use of regional anesthesia for the
procedure.
Addition of opioid, like morphine, to intrathecal and/or epidurally
administered local anesthetic provides an easy and effective means to
maintain prolonged postoperative analgesia. Neuraxial techniques may be
used for post cesarean delivery pain relief even in women having general
anesthesia, if they so desire, once they are awake. Adverse effects of
intrathecal opioids have been reported widely and include pruritus,
nausea and vomiting, urinary retention, and early or delayed respiratory
depression. Pruritus may be the most frequent and bothersome side effect.
Adjuvants such as NSAIDs, α2-agonists, and anticholinergics, may play a
significant role in enhancing the analgesic efficacy of traditional
parenteral or neuraxial opioid-based techniques after cesarean delivery
while at the same time decreasing the potential for side effects by
reducing opioid requirements. Improving the quality and safety of
neuraxial technique is enhanced by the use of ultrasound guidance.
The transversus abdominis plane (TAP) block is a newly described
peripheral block involving the nerves of the anterior abdominal wall. The
initial technique described the lumbar triangle of Petit as the landmark
used to access the TAP in order to facilitate the deposition of local
anaesthetic solution in the neurovascular plane. Many clinical trials that
have been made on TAP block demonstrated clinically significant
reductions of post-operative opioid requirements and pain, as well as
some effects on opioid-related side effects (sedation and post-operative
nausea and vomiting).