Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 318: Pain During C-Section Revisited with Drs. Hofkamp and Sharpe
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Oct 5, 2025 Dr. Mike Hofkamp and Dr. Emily Sharpe, experts in obstetric anesthesia, delve into the challenges of pain management during cesarean deliveries. They discuss the shift away from general anesthesia due to historical concerns and legal risks, and emphasize the importance of setting patient expectations about pain. The duo addresses how to measure intraoperative pain and the factors influencing it. They also highlight techniques to optimize epidurals and when to convert to general anesthesia, advocating for better pain management and patient autonomy throughout the process.
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From Metric-Chaser To Patient Advocate
- Emily originally tried to reduce GA rates to meet quality metrics but reversed after realizing patient suffering risk.
- That experience shifted her to support appropriate use of GA when neuraxial analgesia fails.
Manage Labor Epidurals Proactively
- Actively manage labor epidurals and replace nonfunctional catheters rather than rely on activation.
- If urgent, use lidocaine or chloroprocaine top-ups; epidural fentanyl can help visceral pain.
Consider Removing Failed Epidurals Early
- Low threshold to remove a poorly functioning labor epidural and perform a new low-dose CSE.
- Removing and redoing neuraxial technique increased odds of regional-only anesthesia (OR ~4.3).
