Raising awareness to prevent, recognise and manage acute pain during caesarean delivery: The French Practice Bulletin

Abstract

The incidence of acute pain during caesarean section varies between studies, with a reported rate ranging between 0.5%-17% for spinal anaesthesia and 1.7%-20% for epidural anaesthesia. Leaders from the French Club anesthésie-réanimation en obstétrique (CARO) convened to provide a clinical framework and practice bulletin to prevent, recognise and treat acute pain during caesarean section. First, a steering group agreed on 5 themes guiding quality of anaesthesia care for caesarean section: (1) appropriate neuraxial anaesthesia and testing of the surgical block prior to incision (PREVENTION); (2) appropriate organisation around decision to delivery time (COMMUNICATION); 3) appropriate management of pain before and/or after skin incision (RECOGNITION & RESPONSE); (4) appropriate prevention, identification and management of post-traumatic stress disorder (SCREENING, PREVENTION AND MANAGEMENT OF COMPLICATIONS); (5) management of medico-legal issues (MITIGATION). Then, an interdisciplinary multi-professional taskforce composed of obstetric anaesthesiologists, obstetricians, neonatologists, psychiatrists, midwifes, nurse anaesthetists, lawyers and patients, developed 23 statements that contribute to optimise care for caesarean section under neuraxial anaesthesia, of which 10 were deemed key recommendations. A decision-tree was built to optimise prevention, communication, recognition, response and management. The aim of this practice bulletin, which was endorsed by 6 societies, is to raise awareness on the risks associated with severe acute pain during caesarean section and to provide best clinical practices; pain during caesarean is not acceptable and should be prevented and managed by all stakeholders.

Keywords: Analgesia; Caesarean section; Neuraxial anaesthesia; Pain; Practice bulletin; Prevention; Recommendations; Surgical block.