[CG] Analgesia following caesarean section or 3rd/4th degree tear repair


exp date isn't null, but text field is

Please report any inaccuracies or issues with this guideline using our online form

This algorithm is intended for patients who have had a spinal/epidural anaesthetic with neuraxial opioid.

First 24h

  • PARACETAMOL 1g qds
    • reduce dose to 500mg if bodyweight <50kg
  • DICLOFENAC 50mg tds
    • starting 8-12h after 100mg diclofenac suppository
    • omit if genuine contraindication to NSAIDs (eg true allergy, previous gastric ulcer, asthmatics with known NSAID intolerance)
    • prescribe PPI/H2 antagonist if history of gastritis with NSAIDs
  • MST 20mg one dose (two 10mg tablets)
    • prescribe as once-only dose on front of kardex
    • at least four hours after spinal opioid
    • timed to fit in with drug rounds (0800, 1400, 1800, 2200)
    • reduce dose to 10mg if bodyweight <50kg
  • MST 10mg one dose (one 10mg tablet)
    • prescribe as once-only dose on front of kardex
    • approximately 12 hours after the previous dose
  • Morphine Sulphate (Immediate Release)*10mg as required (*(SEVREDOL brand name in GCC)
    • up to once hourly (first dose AT LEAST two hours after MST)
    • if more than 3 doses requested, consider medical review
  • Prescribe LAXIDO (1 sachet once or twice per day)
  • Please also prescribe at least one anti-emetic

Second 24h

  • STOP Morphine Sulphate before discharge
  • Continue regular PARACETAMOL and DICLOFENAC
  • If the patient has a genuine contraindication to NSAIDs, or a history of chronic pain, or is still has inadequately controlled pain consider adding DIHYDROCODEINE 4 hourly as required

For discharge

  • Aim for discharge on PARACETAMOL and DICLOFENAC only
  • NO PATIENT will be discharged home on morphine sulphate
  • Patients being discharged on day 1 or 2 who have a genuine contraindication to NSAIDs, or pre-existing chronic pain issues or who still have moderate pain may need a small supply of DIHYDROCODEINE 4 hourly as required

Last reviewed: 04 November 2019

Next review: 30 November 2022

Author(s): Dr Drew Smith, Consultant Anaesthetist, PRM on behalf of Obstetrics Guidelines Group – SLWG on Postoperative analgesia

Version: 2.1

Approved By: Dr Catrina Bain, Clinical Director, Obstetrics GGC