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Uncontrolled pain following caesarean section can profoundly and negatively on a wide range of patient and healthcare\u2010centred outcomes. The aim of this systematic review was to update existing recommendations for postoperative pain management after elective caesarean section performed under neuraxial anaesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review using the PROcedure SPEcific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised trials evaluating the efficacy of analgesic, anaesthetic and surgical interventions were retrieved. Systematic reviews and meta\u2010analyses of randomised controlled trials were also reviewed. Trials evaluating pain management for emergency surgical deliveries or caesarean section performed under general anaesthesia were not included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty\u2010one randomised controlled trials were included. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, we recommend that clinicians administer intrathecal morphine 50\u2013100\u2009\u03bcg or diamorphine 300\u2009\u03bcg pre\u2010operatively, and paracetamol, non\u2010steroidal anti\u2010inflammatory drugs and dexamethasone after delivery. If a neuraxial opioid is not administered, clinicians should use one of a range of recommended fascial plane blocks; alternatively, the wound should be infiltrated with local anaesthetic. 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. The peritoneum should not be closed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>An analgesic regimen to manage pain safely and effectively after elective caesarean section based on up\u2010to\u2010date evidence is presented. Consideration has been given to balancing analgesic efficacy and potential adverse effects. Future research should determine the optimal dose of dexamethasone and epidural long\u2010acting opioid, establish the most effective regional analgesic technique and develop standardised outcome sets to better compare techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70141","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:54:46Z","timestamp":1771224886000},"page":"819-839","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Pain management after elective caesarean section under neuraxial anaesthesia: an updated systematic review and procedure\u2010specific postoperative pain management (\n                    <scp>PROSPECT<\/scp>\n                    ) recommendations"],"prefix":"10.1111","volume":"81","author":[{"given":"Gillian","family":"Crowe","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine Cork University Hospital  Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Atterton","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine St James's Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Roofthooft","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology ZAS Sint\u2010Augustinus \u2013 Sint\u2010Vincentius Hospitals  Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish P.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management University of Texas Southwestern Medical Center  Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narinder","family":"Rawal","sequence":"additional","affiliation":[{"name":"Institution for Medical Sciences, \u00d6rebro University  \u00d6rebro 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