Adherence to an intraoperative and post-cesarean analgesia protocol: a before-and-after implementation study…

Cohort studyInternational journal of obstetric anesthesia· Aug 2026

Adherence to an intraoperative and post-cesarean analgesia protocol: a before-and-after implementation study in a large academic center (2024-2025).

A Ronenson, A Ioscovich, D Shatalin … Y Gozal

Obstetric AnesthesiaCohort studyQ2IF 1.7

Post-cesarean pain in recovery unit fell sharply after anesthesia protocol implementation

Adherence to an intraoperative and post-cesarean analgesia protocol: a before-and-after implementation study in a large academic center (2024-2025).

A Ronenson … Y Gozal

International journal of obstetric anesthesia · Aug 2026 · Q2 in Anesthesiology

Background

Optimized pain management after cesarean delivery is essential for adequate maternal recovery.

Methods

This single-center prospective before-and-after cohort study evaluated the adherence to an intraoperative anesthesia protocol and a postoperative nursing protocol after implementation of these two protocols for women undergoing term cesarean delivery, between May 2024 and July 2025.

n = 202 cases

Results

recovery-room pain after cesarean dropped sharply post-protocol

PACU pain pre-implemen

33.6%

PACU pain post-impleme

4%

More results

Intraoperative adherence improved rapidly, exceeding 90% within three months and reaching 96% by 10 months.

In contrast, postoperative adherence remained poor across postoperative days 1-3 (71.3%, 13.9%, and 3%, respectively), with persistently high rates of postoperative pain (VAS >3) of 52.5%, 60.4%, and 24.8%, respectively.

“

Conclusion · 1 of 2

After implementation of protocols intended to improve post-cesarean analgesia, quasi-universal adherence to the intraoperative multimodal analgesia protocol was achieved within the first three months and was associated with significantly improved pain scores in the post-anesthesia care unit.

Conclusion · 2 of 2

Targeted multidisciplinary strategies are required to improve implementation across all phases of care.

Adherence to an intraoperative and post-cesarean analgesia protocol: a before-and-after implementation study in a large academic center (2024-2025).

Adherence to an intraoperative and post-cesarean analgesia protocol: a before-and-after implementation study in a large academic center (2024-2025).

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