Acute pain is a common complication following cesarean section under general anesthesia. Post–cesarean section pain management is crucial for both the mother and the newborn.

The present study published in the Journal of Pain Research compared the effects of patient-controlled intravenous analgesia (PCIA) using sufentanil or tramadol on postoperative pain control and initiation time of lactation in patients who underwent cesarean section under general anesthesia. Primiparas (n=146) scheduled for cesarean section under general anesthesia were randomized to receive PCIA with sufentanil or tramadol and postoperatively evoked movement. The rest-pain intensity was assessed by the Numerical Rating Scale (NRS). The number of PCIA attempts, the consumed drug,  lactation initiation time, and Recovery Quality Score 40 (QoR-40) were recorded at 4, 8, 12, and 24 h postoperatively and also recorded pre- and postoperative serum prolactin levels. Resultant no significant between-group difference existed in the NRS at rest at any time point and patients on sufentanil had more movement-evoked pain and a higher sedation score at 4, 8, and 12 h postoperatively, as compared with the tramadol group. At 24 h, the QoR-40 and postpartum prolactin levels with a significant delay in initiation of lactation were significantly higher in the tramadol group compared with the sufentanil group. Under general anesthesia following cesarean section, PCIA preferred with tramadol may be due to lower movement-evoked pain, higher quality of recovery, and earlier lactation in patients.