Intérêt de l’instillation pariétale unique de ropivacaïne dans la prévention des douleurs après césarienne

Ducarme, Guillaume; Sillou, S.; Wernet, Anne; Davitian, C; Poujade, O; Ceccaldi, P F; Bougeois, B.; Luton, Dominique

doi:10.1016/j.gyobfe.2011.07.035

Cited by 14 publications

(3 citation statements)

References 30 publications

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“…One hour after the surgery, there was the biggest difference in pain scores; however, after four hours, there was not any difference between groups. Similar findings have been made by a number of other researchers [19][20][21][22].…”

Section: Discussionsupporting

confidence: 90%

A Comparison of Post-Operative Pain Relief After Elective LSCS With Local and Intraperitoneal Ropivacaine Instillation Against Local Ropivacaine Infiltration Alone

Tripathi

THAKRE

NARREY

et al. 2023

Asian J Pharm Clin Res

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Objectives: For an anesthesiologist, the post-operative phase is just as crucial as the pre-operative and intraoperative periods. Whether a surgery is performed under regional or general anesthesia, the goal should always be to provide patients with a pain-free and comfortable recovery. Spinal anesthesia is frequently used during caesarean sections, but its effects only last for a few hours. As a result, various multidisciplinary analgesia strategies with few side effects have been attempted for postpartum patients to relieve pain because they may also be harmful to the newborn baby’s health. It has already been proven; injecting ropivacaine is a far safer alternative to injecting bupivacaine. We compared local infiltration of injectable ropivacaine alone to both intraperitoneal instillation and local infiltration for post-operative analgesia in individuals who had cesarean surgery. In the present study, intraperitoneal instillation and local infiltration of ropivacaine 0.5% were compared to local infiltration of ropivacaine 0.5% alone for the management of post-operative pain following elective cesarean section under spinal anesthesia. Methods: Pregnant women in ASA Grades I and II who were having a planned caesarean section under spinal anesthesia were divided into two groups at random (R1 and R2 group, each have 30 patients). Patients in Group R1 received a 15 mL injection of 0.5% ropivacaine at the incision site. Patients in Group R2 had intraperitoneal injections of 0.5% ropivacaine in 5 mL before to peritoneal closure and local infiltrations of 10 mL ropivacaine at the site of the incision before skin closure. The duration of the analgesia was calculated by timing the start of the sensory block to a point at which rescue analgesia was sought throughout the post-operative period. Pain intensity was measured using the visual analog scale (VAS). Data on the hemodynamics and side effects of the patients were also gathered. Results: Group R2 analgesia lasted much longer than that of Group R1 (p<0.05). The mean (±SD) analgesic duration in the R1 and R2 groups was 147.17±4.67 and 170.33±3.69 min, respectively. The mean (SD) VAS scores for Group R1 and Group R2 at the moment of the first analgesic demand were 36.7±5.14 and 32.6±6.52, respectively. Conclusion: When combined with intraperitoneal instillation during spinal anesthesia, inj. ropivacaine 0.5% local infiltration enhances post-operative analgesia in cesarean section procedures.

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Section: Discussionsupporting

confidence: 90%

A Comparison of Post-Operative Pain Relief After Elective LSCS With Local and Intraperitoneal Ropivacaine Instillation Against Local Ropivacaine Infiltration Alone

Tripathi

THAKRE

NARREY

et al. 2023

Asian J Pharm Clin Res

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“…We included 114 trials (8730 women) in our final network analysis, 73 (64%) of which reported the primary outcome of morphine equivalent dose in the first 24 postoperative hours for 5126 (59%) women (Fig. 1 and online Supporting Information, Table S1) [14–127]. Placebo vs. transversus abdominis plane injection in 11 trials was the most common direct comparison.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: a network meta‐analysis of randomised controlled trials

et al. 2021

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Caesarean delivery is common and can cause severe postoperative pain but injection of local anaesthetic at various sites for regional blocks or local anaesthetic infiltration may reduce this. We aimed to compare and rank these sites. We searched PubMed, Google Scholar, EMBASE and CENTRAL to June 2021 for randomised controlled trials and performed a random-effects Bayesian model network meta-analysis. The primary outcome was dose of parenteral morphine equivalents in the first 24 postoperative hours. We used surface under cumulative ranking probabilities to order techniques. We analysed 114 trials (8730 participants). The ordered mean (95% credible interval) reduction in morphine equivalents, from 34 mg with placebo, were as follows: ilioinguinal 15 (1-32) mg; ilio-inguinal-iliohypogastric 13 (6-19) mg; transversalis fascia 11 (4-26) mg; erector spinae 11 (10-32); transverse abdominis 9 (4-13) mg; wound catheter infusion 8 (2-15) mg; quadratus lumborum 8 (1-15) mg; wound infiltration 8 (2-13) mg; and no intervention À4 (À10 to 2) mg. Ordered efficacies for injection sites were different for other relevant outcomes, including pain (to 4-6 h and to 24 h) and time to rescue analgesia: there was no single preferred route of injection. The ordered mean (95% credible interval) reduction in dynamic pain scores (0-10 scale) at 24 h compared with placebo were as follows: wound infusion 1.2 (0.2-2.1); erector spinae 1.3 (À0.5 to 3.1); quadratus lumborum 1.0 (0.1-1.8); ilio-inguinaliliohypogastric 0.6 (À0.5 to 1.8); transverse abdominis 0.6 (À0.1 to 1.2); wound infiltration 0.5 (À0.3 to 1.3); transversalis fascia À0.8 (À3.4 to 1.9); ilio-inguinal À0.9 (À3.6 to 1.7); and no intervention À0.8 (À1.8 to 0.2). We categorised our confidence in effect sizes as low or very low.

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“…Single-shot wound infiltration in cesarean delivery has a limited analgesic duration of 4–12 h [ 51 , 52 ]. Therefore, continuous wound infiltration is preferred over a single injection.…”

Section: Special Concerns About Pain Control In Cesarean Deliverymentioning

confidence: 99%

The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review

Sangkum

Thamjamrassri

Arnuntasupakul

et al. 2021

Anesthesiology Research and Practice

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Optimal postoperative analgesia has a significant impact on patient recovery and outcomes after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery and pain management. For a standard analgesic regimen, the use of long-acting neuraxial opioids (e.g., morphine) and adjunct drugs, such as scheduled acetaminophen and nonsteroidal anti-inflammatory drugs, is recommended unless contraindicated. Oral or intravenous opioids should be reserved for breakthrough pain. In addition to the aforementioned use of multimodal analgesia, preoperative evaluation is critical to individualize the analgesic regimen according to the patient requirements. Risk factors for severe postoperative pain or analgesia-related adverse effects will require modifications to the standard analgesic regimen (e.g., the use of ketamine, gabapentinoids, or regional anesthetic techniques). Further investigation is required to determine analgesic drugs or dose alterations based on preoperative predictions for patients at risk of severe pain. Outcomes beyond pain and analgesic use, such as functional recovery, should be determined to evaluate analgesic treatment protocols.

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Intérêt de l’instillation pariétale unique de ropivacaïne dans la prévention des douleurs après césarienne

Cited by 14 publications

References 30 publications

A Comparison of Post-Operative Pain Relief After Elective LSCS With Local and Intraperitoneal Ropivacaine Instillation Against Local Ropivacaine Infiltration Alone

A Comparison of Post-Operative Pain Relief After Elective LSCS With Local and Intraperitoneal Ropivacaine Instillation Against Local Ropivacaine Infiltration Alone

Efficacy of regional blocks or local anaesthetic infiltration for analgesia after caesarean delivery: a network meta‐analysis of randomised controlled trials

The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review

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