226 posters, 5 topics, 20 sessions, 598 authors, 292 institutions
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Obstetric Anaesthesia Annual Scientific Meeting 2026
14-15 May 2026 | Liverpool Convention Centre
7162475
Post-operative analgesia and opioid use after caesarean section
Part of Topic
Quality Improvement
POSTOPERATIVE ANALGESIA AND OPIOID USE AFTER CAESAREAN SECTION
Emma Durrant, Catherine Collinson
Introduction
Post-caesarean analgesia must balance effective pain control with opioid stewardship. Inadequate analgesia is associated with persistent pain, postnatal depression and reduced breastfeeding success. However, opioid exposure carries significant risk.² International guidelines recommend minimising in-hospital opioid use and limiting discharge prescriptions. Reducing in-hospital opioid use after delivery and amount of opioid prescribed after discharge is recommended by SOAP, ACOG, ABM. We evaluated in hospital and discharge analgesic use and patient understanding following lower segment caesarean section (LSCS).
Methods
•Retrospective review of electronic records for 100 patients undergoing LSCS under regional anaesthesia in September 2023 on in-hospital and discharge analgesia
•Telephone survey with 15 patients 2 weeks post LSCS in May 2025
•Questions on pain scores, analgesia use and analgesia disposal practice
•Registered with local QI team and Caldicott Guardian
Results
Patient demographics
•74% emergency LSCS, 26% elective
•Average length of stay 2.8 days
In-hospital analgesia
•All patients were prescribed oral morphine solution 10mg
•Average of 3.95 doses used.
•58% of patients used three doses or fewer.
•Use varied by urgency — emergency LSCS patients used 2.8 doses, compared with 5.7 after elective delivery
- Strong multimodal prescribing
Discharge and home analgesia
•96% discharged with 200mg bottle oral morphine solution, Including 20% who had used none in hospital
•Patients reported pain as worse at home than in hospital
•4/15 patients finished the full supply within five days when taking as prescribed.
•Several reported oramorph use with ‘mild’ pain
•No patients received any information on safe disposal, with all either retaining unused morphine at home or completing the supply.
Discussion
This survey identified gaps in post-operative analgesia guidance and opioid stewardship. Patients lacked clear advice on analgesia scheduling, appropriate opioid use and safe disposal. This is of particular concern given the dangers of unsued opioids in the home In an opioid-naïve patient, this can be a fatal dose. This is important in this group given that MBRRACE: death by suicide is a leading cause of maternal death. In response, we have engaged with pharmacy colleagues to clarify disposal pathways and plan to introduce a patient information guide using a traffic-light system for analgesia use, alongside clear disposal instructions for unused oral morphine. The initial study was conducted prior to implementation of MHRA guidance on post operative long acting opioids and our prescribing protocol has now changed. A repeat survey is planned following implementation and updated post operative pain relief protocols.