Updated PROSPECT Guidance Reshapes Post-Caesarean Analgesia Regimens

This 2026 PROSPECT update consolidates neuraxial opioid, dexamethasone, and fascial plane block recommendations for elective caesarean section, giving pharmacists a current framework for multimodal analgesia protocols.

intrathecal morphinediamorphinedexamethasoneNSAIDsparacetamoltransversus abdominis plane blockquadratus lumborum blockerector spinae plane blockilioinguinal iliohypogastric blocktransversalis fascia plane blockliposomal bupivacaineesketaminedexmedetomidinecaesarean sectionpostoperative painPROSPECT guidelineobstetric anaesthesiasystematic review Pain / Palliative Care

Background Information

Optimizing pain relief post-caesarean ensures faster, safer recovery.

Effective pain management after caesarean section improves recovery for both mothers and infants. Intrathecal morphine or diamorphine before surgery, regular paracetamol and NSAIDs, and selective use of opioids postoperatively are recommended. The study emphasizes a balanced approach to analgesia with specific regimens, supporting clinical decisions with evidence from 61 trials. Updated evidence-based strategies improve postoperative pain management after elective caesarean section.

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Authors: Crowe G, Atterton B, Roofthooft E, Joshi GP, Rawal N, Wu C, Sauter AR, Bonnet MP, Lucas DN, Van de Velde M, PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy

Citation: Crowe G, Atterton B, Roofthooft E, et al. Pain management after elective caesarean section under neuraxial anaesthesia: an updated systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Anaesthesia. 2026;81(6):819-839. doi:10.1111/anae.70141

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Executive Summary

Study Design

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