Alternate Management

Alternate Management is a multimodal analgesic and recovery protocol developed by Dr. Norman A. Brest for the management of postoperative pain and recovery following cesarean section. The protocol is designed to reduce the consumption of narcotic analgesics and accelerate the return of normal physiological functions, such as bowel motility. It employs a combination of preoperative and postoperative non-opioid medications, including the cyclooxygenase inhibitors acetaminophen, ketorolac, and ibuprofen, the voltage-gated calcium channel ligand gabapentin, and the 5-HT3 receptor antagonist ondansetron. In addition to its pharmacological components, the protocol incorporates clinical management strategies such as early ambulation, early removal of urinary catheters, and immediate advancement to a regular diet. This integrated approach aims to improve patient outcomes and satisfaction while minimizing the morbidity associated with opioid use in the postpartum period.

Other names

Alternate Recovery Protocol