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The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure\u2010specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50\u2013100\u00a0\u00b5g or diamorphine 300\u00a0\u00b5g administered pre\u2010operatively; paracetamol; non\u2010steroidal anti\u2010inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single\u2010injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and\/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non\u2010steroidal anti\u2010inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel\u2010Cohen incision; non\u2010closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.<\/jats:p>","DOI":"10.1111\/anae.15339","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T18:41:07Z","timestamp":1609180867000},"page":"665-680","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":320,"title":["PROSPECT guideline for elective caesarean section: updated systematic review and procedure\u2010specific postoperative pain management recommendations"],"prefix":"10.1111","volume":"76","author":[{"given":"E.","family":"Roofthooft","sequence":"first","affiliation":[{"name":"Department of Anesthesiology GZA Sint\u2010Augustinus Hospital Antwerp Belgium"},{"name":"Department of Cardiovascular Sciences KULeuven and UZLeuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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