Condition reference
PainCesarean section pain management
Explore the linked guideline and related drug references. A matching drug entry does not establish a treatment recommendation.
WSAVA guideline
Guidelines for the Recognition, Assessment and Treatment of Pain
Pregnancy physiology (↓GI motility, enlarged uterus, high O2 needs, inhalant requirement −25–40% at term) dictates caesarean anaesthesia, and all anaesthetic and analgesic agents cross the placenta; evidence is stronger for dogs than cats (card). Premedication is normally recommended (less stress, lower induction doses, opioid pre-emptive analgesia) using less emetogenic opioids because vomiting/aspiration contributes to maternal mortality. Opioids before delivery have not been shown to harm offspring; depressed/bradycardic neonates receive naloxone (umbilical vein or sublingual). LAs are safe and highly recommended, α2 agonists (xylazine contraindicated) and methoxyflurane increase mortality, and a single post-op NSAID dose is a "suitable compromise" once hypovolaemia/hypotension are corrected.
WSAVA Pain GL 2022/2023 (JSAP doi 10.1111/jsap.13566) — Caesarean card + GPC pregnant/lactating sheet; Repro GL 2024 cross-ref
Key findings
- Intubation always warranted; mask inhalant induction not recommended; pre-oxygenate 3–5 min; IV fluids before induction (card).
- Pre-op opioids — less emetogenic: buprenorphine, butorphanol, methadone, pethidine; opioids before delivery have not been shown to adversely affect offspring (card).
- Bradycardic offspring → naloxone via umbilical vein or sublingually — "a drop of naloxone sublingually; repeat dosing may be needed" (card; addendum). ⚠️ Buprenorphine caused lack of milk production in animal studies — a problem post-caesarean (addendum).
- NSAIDs: small % of the dam's dose enters milk; single post-op dose = suitable compromise once hypovolaemia/hypotension corrected; avoid in pregnancy (teratogenic); non-COX-selective/COX-1 haemorrhage concern post-partum (card; addendum).
- Xylazine and methoxyflurane ↑ maternal/neonatal mortality; med/dexmedetomidine best avoided (emesis, CV depression, ↓uterine blood flow); ketamine ↑ uterine tone → avoid in pregnancy (card; addendum).
- LAs safe, non-teratogenic — highly recommended; epidural volume −25–30% in pregnancy (hypotension risk) (card; addendum).
Drugs named in WSAVA’s own guideline text
As printed in WSAVA’s document, not this app’s own extracted data — see “Related drugs in this reference” below for that.
Opioid premed (buprenorphine, butorphanol, methadone, pethidine) (Bitch/queen)
Sedation + pre-emptive analgesia; ↓ induction dose
Induction agents (Bitch/queen)
Induction/maintenance; emergency analgesia
Naloxone (**Neonates**)
Reverse opioid neonatal bradycardia/depression
Lidocaine/bupivacaine ± epidural morphine (Bitch/queen)
Incisional/epidural analgesia
NSAID (single dose) (Bitch/queen)
Post-op analgesia
Recommendations
Premedicate normally — ↓ stress/induction doses; opioid = pre-emptive analgesia
Expert consensus (card)
Non-emetogenic opioids; always intubate; no mask induction; pre-oxygenate 3–5 min; IV fluids first
Expert consensus (card)
Opioids before delivery acceptable — no adverse offspring outcome shown
Evidence-based (card)
Naloxone (umbilical/sublingual) for affected neonates; supportive care first
Expert consensus (card + addendum)
LA techniques safe and highly recommended in pregnancy
Expert consensus (GPC + addendum)
Single post-op NSAID once volume/BP corrected
"Suitable compromise" (card)
Avoid α2 (xylazine contraindicated) and methoxyflurane
Stated (card)
Neonate gets ~1–2% of maternal dose in milk; pump-and-discard 12 h if concerned
Expert consensus (addendum)
En-bloc SOHE, ≤60 s forceps-to-delivery, IV fluids (context)
Expert consensus (Repro GL 2024 §2.1.1.1.6)
Related drugs in this reference (0)
No indication text currently matches this condition by name. Try a broader condition or search the drug reference directly. Absence of a match does not establish that treatment is unavailable.
From the Caesarean-section card (elective/emergency/no-controlled/limited tiers) + the GPC pregnant-or-lactating addendum in 02-pain-2022.md (from Mathews et al. 2014) + 03-reproduction-2024.md (procedure context). Pain guideline main text (part02/03) has no dedicated caesarean scenario — card + addendum are the sole sources; neonatal naloxone printed only as "a drop sublingually" [verify vs GPC Treatise].