Abstract
Neuraxial analgesia for obstetric and gynecologic open abdominal surgery is often unacceptable in patients receiving antithrombotic therapy. Although optimized pain relief and early mobilization is a prerequisite for thromboprophylaxis, analgesia solely using opioid analgesics may delay postoperative recovery because of the side effects. Multimodal balanced analgesia, the use of a combination of non-opioid analgesics, local infiltration analgesia/regional block and intravenous patient controlled analgesia (IV-PCA) with an opioid, is recommended for reducing opioid consumption and improving analgesia. Planning of context-sensitive pain management including constant patient monitoring through pre-, intra- and post-operative and post-discharge stages is vital.
