Obstetric Anesthesia Core Knowledge Modules-Post-cesarean Pain Management Order Set

Post-cesarean Pain Management Order Set

Pdf Summary

The post-cesarean pain management plan prioritizes scheduled acetaminophen and ibuprofen, neuraxial morphine—or a bilateral TAP/QL block if morphine is omitted or contraindicated—and opioid-sparing rescue treatment.<br /><br />In the PACU, patients who received neuraxial morphine continue scheduled non-opioid analgesics, with opioids reserved for breakthrough pain. Fentanyl may be given every five minutes as needed: 12.5 mcg for mild, 25 mcg for moderate, or 50 mcg for severe pain. PACU options for nausea include ondansetron, dexamethasone, prochlorperazine, and peppermint oil. Itching may be treated with nalbuphine or diphenhydramine.<br /><br />Postpartum, scheduled analgesia is acetaminophen 975–1,000 mg by mouth every eight hours (maximum 4 g daily) and ibuprofen 400 mg every six hours. For breakthrough pain, oxycodone 5 mg every four to six hours as needed is recommended for moderate pain, and 10 mg for severe pain. Pruritus and nausea/vomiting can be treated with as-needed nalbuphine or diphenhydramine, and ondansetron or prochlorperazine, respectively.<br /><br />At discharge, continue acetaminophen and ibuprofen, with oxycodone 5 mg every four to six hours as needed for severe pain; dispense no more than 10 tablets.

Keywords

post-cesarean pain management

scheduled acetaminophen

ibuprofen

neuraxial morphine

TAP block

QL block

opioid-sparing rescue

PACU analgesia

oxycodone

postpartum discharge pain control