Scheduled versus on-demand nonopioid analgesia after cesarean delivery under regional anesthesia: a meta-analysis of randomized controlled trials

Effective pain relief after cesarean delivery is crucial for maternal comfort, recovery, and breastfeeding. Although scheduled nonopioid analgesics are standard, on-demand regimens have been suggested to reduce drug exposure. PubMed/MEDLINE, Embase, Scopus, and Cochrane CENTRAL were systematically searched from inception to August 20, 2025, for randomized controlled trials (RCTs) comparing scheduled vs. on-demand nonopioid analgesia following cesarean delivery under regional anesthesia. The primary outcomes were postoperative pain intensity and analgesic consumption, and the secondary outcomes were maternal satisfaction, adverse effects, breastfeeding outcomes, and neonatal safety. Three RCTs that included 666 women were identified. At 24 h, scheduled dosing significantly reduced pain scores compared with on-demand regimens (mean difference [MD] 0.98, 95% confidence interval [CI] 0.55 to 1.41; P < 0.001, I2 = 78%), but no difference was observed at 48 h (MD 0.76, 95% CI –0.30 to 1.82; P = 0.16, I2 = 96%). Overall analgesic consumption did not differ significantly between groups (standardized MD –0.23, 95% CI –0.62 to 0.16, P = 0.24; I2 = 80%). Maternal adverse effects were rare and similar across groups (risk difference −0.01, 95% CI −0.04 to 0.02; I2 = 0%). Breastfeeding outcomes were inconsistently defined, with two trials indicating benefits from scheduled dosing. Neonatal safety outcomes were reported in one trial, showing no differences between groups. Scheduled nonopioid analgesia after cesarean delivery under regional anesthesia was linked to better pain control during the first postoperative day. After this period, the comparative effectiveness of scheduled vs. on-demand regimens remained uncertain, with considerable variability across studies. No significant differences were found in analgesic consumption or maternal adverse effects, and evidence regarding breastfeeding and neonatal outcomes was limited.