Analgesia after Caesarean section: are neuraxial techniques outdated?

Parturients do not feel ill and bedridden like other patients undergoing the same incision. Therefore they dislike motor impairment which is at risk with catheters placed in the lumbar area. The problems with breast feeding are overemphasized but may partly explain the increase in popularity of other modalities such as the use of minor analgetics, single dose spinal morphine covering the first 24 hours, TAP blocks and wound related techniques. More studies are required to determine the optimal catheter placement, nature, dose and concentration of drugs given into the wound or their improved outcome justifying their increased cost. Similarly more cost/benefit studies should be performed to evaluate whether the pain in these patients is not underestimated and undertreated and how outcome can be further improved and discharge accelerated. Especially with a 50% shortening of the hospitalisation noticed during the last 1015 years, optimisation of post-caesarean delivery pain may play a more important role, but obstetricians should determine discharge criteria more strictly.