Pain during caesarean section under neuraxial anaesthesia is a significant concern, with potential psychological and medicolegal consequences. The failure rate of neuraxial anaesthesia varies, with spinal anaesthesia failing in 6% of cases and epidural top-ups in 24%. Risk factors include increased BMI, operative urgency, and inadequate anaesthetic spread. An adequate block should reach the T5 dermatome to prevent intraoperative pain. Assessment includes sensory, motor, and autonomic evaluations, with light touch being the primary modality. Effective communication with the patient is crucial, as well as ensuring reassurance, prompt recognition of distress, and proper documentation. Pain management strategies depend on urgency and surgical stage. If pain occurs before delivery, neuraxial supplementation, intravenous opioids, ketamine, or conversion to general anaesthesia may be required. If the patient experiences pain, the surgical team should be informed, surgery should be paused if possible, and the block reassessed before proceeding. Thorough documentation and follow-up are essential to reduce medicolegal risk. This article highlights the importance of adequate block assessment, prompt intervention, and patient-centred communication in managing pain during caesarean section.