Which Oral Drug Is Best for Post-Cesarean Pain?


A meta-analysis sought to determine which oral painkillers were most effective after a c-section, but the findings were disappointing.

Pain medications are a common prescription for post-cesarean care, but little scientific evidence exists proving which drug is most effective.

Researchers from the Cochrane Pregnancy and Childbirth Group concluded that the data for oral painkillers is insufficient and called for larger, better-designed studies that could shed light on the safest and most effective way to manage post-cesarean pain.

Key Finding:

- Little scientific evidence is available when it comes to understanding the safest and most effective way to treat post-cesarean pain, according to a Cochrane meta-analysis.

For the meta-analysis, the authors identified just eight studies involving a combined 962 women. However, only half the studies were deemed “high quality,” and those were all small, each involving between 40 and 136 women.

“Due to limited data available, no conclusions can be made regarding the safest and the most effective form of oral analgesia for post-caesarean pain,” the authors concluded. “Further studies are necessary. More research is needed to compare different types of painkillers and in relation to different outcomes such as safety, efficacy and cost.”

The authors found no data on important secondary outcomes, such as number of postoperative hospital days, re-hospitalization due to incisional pain, fully breastfeeding on discharge, mixed feeding at discharge, pain at the incision site 6 weeks post-cesarean, maternal postpartum depression, effect (negative) on mother and baby interaction, and cost of treatment.

The analysis attempted to compare non-opioid, opioid, and a combination of oral tablets with placebo or no treatment. However, there was insufficient evidence to determine the effect of additional painkillers (pills or injections) among women who took opioid or non-opioid or combination painkillers in comparison to placebo.

In addition, the analysis couldn’t even answer the question of what type of analgesia-opioid, non-opioid, or a combination of painkillers-offers the best pain relief.

When looking at non-opioid drugs, the researchers found some evidence that use of gabapentin resulted in less need for additional pain relief compared with placebo, but the analysis of data for other tablets (celexocib, ibuprofen, ketoprofen, naproxen, and acetaminophen [paracetamol]) gave more uncertain results.

Prescribing acetaminophen plus codeine resulted in less need for additional pain relief in comparison to placebo. Also, both high and low doses of gabapentin, and a high dose of ketoprofen, were more effective than placebo in relation to the need for additional pain relief.

Still, a low dose of ketoprofen, as well as high and low doses of tramadol, did not differ with placebo in terms of pain control.

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