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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Historical Fear Shaped Current Practice
- Historical fear of obstetric general anesthesia drove rates down despite patient suffering.
- Joy Hawkins' 1997 closed-claims data framed GA as 17-fold risk compared to neuraxial, shaping practice.
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.
Metrics Can Drive Unintended Consequences
- Quality metrics (e.g., <5% GA) incentivized lowering GA rates, sometimes without context.
- Audit and contextual review are necessary because some hospitals legitimately need higher GA rates.
