Continuous wound infiltration of bupivacaine at two different anatomical planes for caesarean analgesia – A randomised clinical trial

Abstract

Background and Aims: Continuous wound infiltration of local anaesthetics provide postoperative analgesia by peripheral nociceptors blockade.The placement of wound infiltration catheter in the optimal anatomical plane of surgical wound may play a significant role in reducing postoperative pain depends on the surgical procedure. We hypothesised that preperitoneal infusion of local anaesthetics will reduce the postoperative opioid consumption as compared to subcutaneous infusion following cesarean section. Methods: This was a randomised, double-blinded clinical trial. Fifty-two pregnant women who underwent lower segment caesarean section by Pfannensteil incision, under spinal anaesthesia, were randomised to group 'subcutaneous’ and group ’preperitoneal’. A wound infiltration catheter was placed in the subcutaneous or preperitoneal plane, depending on their randomisation at the end of the surgery. Bupivacaine of 0.25% at 5 mL/h was infused for the next 48 h. Pain was assessed using numerical rating scale at 1, 2, 3, 4, 5, 6, 12, 24, 36 and 48 h after surgery. Cumulative postoperative consumption and adverse effects of morphine and complications of the procedure were looked for. Results: Cumulative 48-h morphine consumption showed no statistical significance between the preperitoneal group (15.96 ± 7.69 mg) and subcutaneous group (21.26 ± 11.03 mg); P = 0.058. Pain score was comparable. Independent T -test and Mann–Whitney test were the statistical tests used for continuous and categorical data, respectively. Conclusion: Postoperative cumulative morphine consumption and pain scores are comparable when bupivacaine is infused continuously through wound infiltration catheter either in the preperitoneal or subcutaneous layer following Caesarean delivery.

Evaluation of Analgesic Effect of Bupivacaine Injection into Both Angles of the Rectus Sheath Incision after an Elective Caesarean Section

“…Our results displayed that group B had significantly longer hospital stay duration compared to group A (P<0.001). The average duration of hospital stay was 5.52 ± 0.87 days in the subcutaneous group and 5.32 ± 0.69 days in the preperitoneal group, (P = 0.37) (24) . Regarding incidence of PONV, comparable to our findings, a study concluded that the overall incidence of nausea was greater in controls (1 1 of 35) than for those given bupivacaine (3 of 35) (p=O.O46).…”

Transversus abdominis plane block versus wound site infiltration using 0.25% bupivacaine for post-operative analgesia after caesarean delivery performed under subarachnoid block

“…Some investigators have also used continuous infusion techniques by putting catheters. 12 Nanze YU et al conducted a meta-analysis including 4 RCTs where they compared analgesic effect of TAP block with WSI in lower abdominal surgeries including caesarean section. They concluded that both have short term (up to 24 hours) analgesic effect but TAP block provide better analgesia by having lower pain scores, lesser need of rescue analgesics and opioid consumptions compared WSI which were consistent with our study results.…”

Assessment of the Safety and Efficiency of a Preperitoneal Continuous Infusion Using Bupivacaine after Abdominal Laparotomy in Digestive Carcinology

“…Given the lack of information on the bioavailability of local anesthetics, especially bupivacaine, administered preperitoneally and the risks associated with their systemic resorption, it seems important to have serum dosages during prolonged continuous infusions. Despite various articles reviewing the efects of wound infltration technique on pain control and outcomes, only a few report complications and limitations [10][11][12][13]; systemic toxic efects and plasma concentrations of local anesthetics have not been studied in most cases.…”