Pain management after GA c section

[ExhaustedPigeon1988]

Hey all, just a little bit of background… I’m currently nearly 38 weeks, I had my pre op yesterday, this is my 2nd baby, my first ended in an emergency c sec, under GA by my request. This time it’s a planned c sec under GA but at a different hospital (the first hospital really let us and bubs down). I was advised by the anaesthetist that pain is worse after GA than epidural, and that she does 2 injections into the lower stomach using ultrasound to avoid nerves etc to inject local anaesthetic before you wake from GA. They don’t have my notes from previous c sec so not sure if I had this done before- I wasn’t told I got them so assume I didn’t- but who knows!

so if you’ve made it this far thank you haha… my question is anyone that’s had GA c sec, did you get these injections, do you recommend them? I’ve initially said I don’t want them, but I just don’t know… was told to have them after I wake from GA wouldn’t be pleasant but could be done… so what as much info from real people as poss about them…. Thanks ladies x

I would recommend them, they usually work well.

sounds like they're talking about TAP blocks - they're pretty routine and work well. Pain after a GA section can be more difficult to control than after spinal/epidural and having TAP blocks can reduce the need for systemic opioids and all their side effects.

Anaesthetic/recovery nurse here currently working on delivery suite- definitely recommend these. They really help with the pain that would normally be relieved by the spinal anaesthetic. You may have had them before but if you had already had an epidural on board before your previous GA section then they may not have done them.
Definitely better having them done before you wake rather than after. You want to wake up comfortable to enjoy those moments with your new baby as soon as you are awake enough to. All the best with your new addition!

Obs anaesthetist

I personally wouldn't choose a ga section as they're more risky and a lot more painful than awake ones post op, but I assume someone's already had a long chat about that already

Theyre called tap (transverse abdominal plane blocks), ultrasound guided LA insertion. Not.all anaesthetists can do it so you may or may not have previously had them. I'd highly recommend you do as very safe and will make the post op pain more bareable

Another anaesthetist.

If you aren’t having an epidural or spinal I’d definitely have the TAP blocks. They are pretty safe and make a difference.

Just out of curiosity to the two anaesthetists above, what makes a GA more painful than having a spinal? Is this the case with most operations?

Kinda. If you have a spinal or epidural we inject opiates directly into the spinal fluid or space next to it, because they work directly on the central nervous system they can be given in tiny doses but still work far better than the equivalent given orally. It hugely reduces the need for oral morphine and hence less nausea constipation sickness etc

Hence any major abdominal surgery we do combined anaesthesia - a spinal or epidural and a GA

it's probably multifactorial (am a 3rd anaesthetist) -
The spinal numbness wears of more gradually than a GA does so it gives a bit of a warning that you need to start taking pain relief before it's really bad.
As well as the local anaesthetic, there's usually diamorphine in the spinal/epidural & that lasts a lot longer than the numbness does and doesn't cause so many general side effects (a lot of women don't really like oral/IV morphine because of the side effects).
The spinal/epidural obtunds the physiological stress response to surgery so there are fewer stress hormones released (those stress hormones can contribute to pain/ fight-or-flight state).
On top of that, the surgeons often have to go quicker with a GA section to reduce the dose of anaesthetic the baby gets (not a problem with a spinal) and there may be a bit more tissue trauma which can contribute to pain (this is also one of the reasons it's pretty typical to prep and drape the abdomen before starting a GA... it cuts down the baby's anaesthetic time if they're not starting from scratch after the GA).
There may be more bleeding with a GA section and if that gets to a certain level then giving an anti-inflammatory painkiller (which is a standard part of the pain relief package) isn't such a good idea and that may contribute to things being less comfortable.

Not every woman has really bad pain after GA sections by any means and for some women GA is absolutely the right decision, but it is more likely to be tricky than after a spinal/epidural so it's sensible to use as many different pain relief modalities as possible to try and make it as easy as possible.

There are lots of operations where we use spinal as default partly because of the better post op pain relief (eg. on it's own in hip/knee replacements/loads of other things, or in combination with GA in major abdominal surgery, most of which can't be done with just a spinal like a c-section can), but also because it's just a nicer anaesthetic to recover from.

Thank you all for your advise, yes now you have mentioned it she did call it a tap block- there was so much information to try take in! So is this standard to have these? What are the risks? Am I silly to not have them? Will they prevent me from being up and about quicker?

Risks are pretty negligible. Main one is it doesn't work perfectly and you need more oral pain killers (this depends on your bmi and anatomy so how obvious the layers are on ultrasound)... but regardless its still better than no block
Bruising or infection cos it's a needle in the skin, but it's kept sterile like surgeons are sterile so no greater risk. Risk of damaging structures (there's v little there to damage, if the needle went super far in then damage to intra abdominal organs but that doesn't really happen with ultrasound

Yes I think it would be silly not to. It's so routine and safe (like surgeons putting local in post op) a lot of anaesthetists wouldn't even tell you they were doing it

No you are far more likely to mobilse sooner or quicker if you have the block, than if you don't, as its pain that will stop you mobilising

But tbh the best of the options would be a spinal and avoiding the GA entirely, they're far higher risk in pregnant people than non pregnant people, be that signficant oxygen drops when going to sleep, difficulties putting the breathing tube in, drug transfer to baby, side effects to you (pain, nausea, feeling groggy etc) so if anything I'd be re-debating the GA and 100% take the nerve blocks if was me

@Destiny123 thank you for your advice, I will defo reconsider the blocks

emc - under epidural. Pain fairly manageable

emc2 - crash section under GA and woke up in sooo much pain!! I was crying!! Fuck me I couldn’t understand why it hurt so much more than the first time but read all the posts by medics above is helpful. They eventually gave me morphine but I was itchy so they stopped that and gosh it was hard having a break in pain relief while we tried to fine an alternative!! I don’t think I had the TAP but which I had if it had been available

Please excuse me if I'm missing the mark here - I'm putting 2 + 2 together. Do you have tokophobia by any chance?

I'm asking this because the first section you mention was GA at your request. I have toko, and a needle phobia and had both of my children via section with spinal.

The idea of using surgery awake was ridiculous to me, so I'm amazed that I did it (twice!). I had the sections because I couldn't face a vaginal birth.

They gave me some form of calming drug into my IV to keep me chilled (but sedated though - I remember it all, but a bit floaty), and they agreed that if I started to panic or requested to be put out during it, they would straight away. So I had my plan B, and ingress I wouldn't be left to panic.

The result was being awake to meet my beautiful babie, having the most amazing memories of that first few minutes (including feeling like a hero for conquering it) and an almost pain free recovery.

It might be that being awake is not something you would consider, and that's your call, but I wouldn't discount it altogether if it's an option available for you.

Otherwise, take all the drugs. Especially ones given when asleep!

@Nc546888 rhat sounds awful. My first baby was born via emergency c sec, I had ga for that too, but at a different hospital and they haven’t/wont transfer my notes, so new hospital don’t have anything I had for me last time- which has really annoyed me, as whatever I had worked well :(

no completely the opposite @Babyboomtastic my dream would be a home birth (my first was meant to be that but after 24hrs of labour ended in emergency c section). Due to a T incision I’ve been told a natural birth is unsafe for me and baby, so it’s a c section. I can’t handle being awake, so I’ve chosen ga, it’s the pain meds I can’t work out.

I had an elective section under G/a for medical reasons some years ago. I came round in excruciating pain. I couldn't function at all just groan. I needed a double dose of morphine injected before I could even acknowledge my daughter, so I would definitely take the nerve blocks!

Sorry for slightly derailing the thread, but one for the anaesthetists. In my trust, TAP blocks are done by the surgeons during GA sections as they close. I'm assuming ultrasound guided are done post surgery before being woken. Is there any difference between the two other than time? Is there a preferred method?

Sorry OP, no advice, but from my memory we do them for every GA section we do in my trust (that didn't have prior epidural/spinal before the GA).

Not really, both are done before you wake up.

Just depends on surgeons training, it's pretty rare o&g know how to do them/do them regularly enough to be good at them (most just do subcut local infiltration into the scar itself)... but if that's the default def go with what's normal for that trust, as it'll be the most frequently done and hence the best