Post-cesarean delivery pain: a case report
Adequate postoperative analgesia is a crucial consideration for women undergoing CD. Post-CD pain is the primary concern for expectant mothers.1 Uncontrolled pain during this period prolongs recovery and interferes with the mother–neonate interaction.

Conversely, appropriate analgesia decreases thromboembolic complications by allowing for early ambulation, thereby reducing a leading cause of maternal morbidity and mortality.

A 25-year-old patient, gravida 3 para 2, at 38 weeks’ gestation, with a body mass index of 36 kg/m2, presented for elective repeat cesarean delivery (CD).

She developed severe pruritus after her 2 previous CDs performed under spinal anesthesia with bupivacaine (10 mg), preservative-free morphine (200 mcg), and fentanyl (20 mcg).

Given her history, spinal anesthesia was performed with bupivacaine (12 mg) and preservative-free morphine (100 mcg). Ondansetron (4 m g) was administered 30 minutes before the spinal, and ketorolac (30 mg intravenously) was given at the end of the surgical procedure and 15 mg every 6 hours, for a total of 24 hours.

The patient did not experience pruritus, and the visual analog pain score after 24 hours was 2, on a scale of 0 to 10.

Learning points:-
• Preoperative identification of risk factors for severe acute or chronic post-CD pain can greatly influence the development of an individualized approach for analgesic treatment.

• Intrathecal morphine alone, although capable of providing adequate analgesia, is not the ideal analgesic for treating post-CD pain.

• A multimodal analgesic approach is preferred in the treatment of post-CD pain.

• Opioids are frequently overprescribed during discharge after CD.

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