“I’m scared of pain before a cesarean section”…what is the best way to manage pain less?

We have entered an era where pregnancy is a ‘plan’ and delivery method is a ‘choice.’ In the past 10 years, caesarean section deliveries, which were previously considered only emergency surgeries, have surpassed the rate of natural deliveries.

According to statistical data, the domestic caesarean section delivery rate more than doubled from 26.9% in 2012 to 58.7% in 2021, and this change was noticeable in all age groups. This also means that mothers are choosing cesarean section for a variety of reasons beyond simple prenatal care. In particular, the mother’s fear of labor pains is considered one of the main factors.

However, mothers who deliver by cesarean section also have pain to endure. Because a cesarean section delivers the fetus through an incision in the abdominal and uterine walls, pain occurs in the wound area after the surgery. Some mothers even complain of extreme pain after surgery, as if their organs were about to spill out. So what pain management methods are being used to relieve the pain of caesarean section mothers?

♦Narcotic analgesic ‘pain-free injection’… There are many side effects such as nausea and vomiting.

In general, self-controlled analgesia (PCA, patient-controlled analgesia), well known as the so-called ‘pain-free injection’, is used to relieve pain after surgery. As the name suggests, when a patient feels pain, he or she can control the pain by controlling the button and injecting a preset amount of painkiller. The drug is mainly injected through a vein or epidural route.

Narcotic analgesics are used in this pain-free injection, and although they are effective in relieving pain, they can cause side effects such as nausea and vomiting, so efforts have been made to reduce the amount used in clinical settings. Recently, in order to reduce the risk of these side effects and the use of narcotic analgesics, there is a trend to use continuous local anesthetic injection (CWI, Continuous Wound Infiltration) at the surgical site.

In fact, the number of cases of using this pain management method in Korea has increased more than fivefold over the past five years. According to the Healthcare Big Data Open System, continuous local anesthetic administration at the surgical site showed a significant increase every year, from 4,575 cases in 2017 to 23,723 cases in 2022.

♦How to administer anesthetic at the surgical site… “Reduce painkiller injection usage and hospitalization days”

Continuous local anesthetic administration at the surgical site refers to a method of continuously administering local anesthetic and controlling pain by inserting a catheter into the surgical site before suturing the incision site after surgery. The local anesthetic spreads through the muscles and fascia of the surgical site and blocks the surrounding nerve tissue, thereby reducing pain.

During the procedure, an injection device consisting of a pump, catheter, and needle is used. This is a method in which the drug charged inside the device is automatically injected into the catheter by pressure, and the drug is continuously administered to the wound site through the hole in the catheter.

This local anesthetic administration method is simple and has high satisfaction because it can reduce the use of narcotic analgesics. According to one study, mothers who used continuous local anesthetic administration at the surgical site showed high satisfaction and reduced hospitalization days.

Director Song Ji-hong of Nowon Media Women’s Hospital said, “The most important thing for a mother is a quick recovery,” and emphasized, “If the pain after a cesarean section is severe, recovery may be delayed, so proper pain management is more important than anything else.”

“Among various pain management methods, the continuous administration of local anesthetic to the surgical site has high satisfaction among mothers because it can reduce the side effects caused by the use of narcotic analgesics,” he said. “At this time, the key to the procedure is to continuously deliver a certain dose of the drug.” . “When choosing a product, it is necessary to consider how uniformly the drug is released through the catheter,” he said.

In addition, since the catheter is inserted into the human body, it is necessary to check whether safe materials are used.

Currently, seven related medical devices, including ‘Pain Fuser’ and ‘Pain Buster’, have received approval and are being supplied to hospitals and clinics. Previously, it was not covered by insurance due to non-reimbursement, but as its usefulness was verified, including the reduction in the use of narcotic painkillers, selective insurance (80%) was applied starting in 2016. Excluding the patient’s own 80% burden, the remaining 20% ​​is covered by health insurance.

Director Song said, “Proper pain management after a cesarean section is a prerequisite for a quick recovery,” and added, “If you are about to have a cesarean section, it is advisable to know enough about post-operative pain management methods and carefully consider the considerations for each product.” .