Local Wound Infiltration with Ropivacaine for Postoperative Pain Control in Caesarean Section

Abstract

BackgroundThe rate of the caesarean section has been on a progressive rise ever since its association with improved fetal prognosis was established. This study was conducted to assess the effect of local wound infiltration with ropivacaine on the postoperative analgesia requirement and pain scores in caesarean section patients.MethodsThis was a prospective single-blinded randomized control trial conducted at the Department of Obstetrics and Gynecology, KRL Hospital, Islamabad, Pakistan over a duration of six months from January 2018 to June 2018. All the women aged 19 to 40 years, who underwent elective caesarean sections under spinal anesthesia, with American Society of Anesthesiologists (ASA) score II, were included in the study and randomized into two groups. The primary outcome studied was the efficacy of ropivacaine in controlling postoperative wound pain compared to no local analgesic. Pain severity was assessed using the visual analog scale (VAS) which was explained to the patient beforehand and which comprised a range of score from zero (no pain) to 10 (worst pain imaginable). Initially, paracetamol 1 g intravenous (IV) was given every six hours, over 24 hours. If pain did not settle on this, ketoprofen 3 mg/kg IV was given every eight hours, and in case of further analgesic demand by the patient, nalbuphine 10 mg was given IV, if necessary. The data was collected on a specific questionnaire and analyzed on the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) version 23.0. A p-value of less than 0.05 was considered significant.ResultsA total of 100 patients were randomized into two groups. Pain scores were significantly reduced in the ropivacaine group at four, six, and 12 hours after surgery. The percentage of patients who requested the multiple doses of IV paracetamol, ketoprofen, and nalbuphine, was significantly lowered in the ropivacaine group as compared to the placebo group (p<0.001).ConclusionsLocal infiltration with ropivacaine during caesarean section significantly reduces the postoperative analgesic requirement and visual analog scores, reducing the incidence of side effects.

Effectiveness of wound site infiltration for parturients undergoing elective cesarean section in an Ethiopian hospital: A prospective cohort study

“…This result is in line with the study done by Nasir F et al [ 19 ] which found a significantly prolonged median time to request the first analgesia (4.49 ± 1.12) in WSI compared to the control group (2.36 ± 0.58). Another prospective cohort study conducted by H Million et al [ 15 ] also showed the extended median time to request the first analgesia in WSI 5.26 (9.03 ± 4.12) compared to the non-exposed group 3.46 (5.02 _2.46).…”

“…With regards to the severity of postoperative pain, our study demonstrated a lower NRS score at the 4th, and 6th hours postoperatively in the WSI group compared to the control group with P-values of <0.001 and 0.04 respectively. Similarly, studies reported a significant reduction of Verbal NRS or VAS pain score at 4th and 6th hr postoperative period respectively [ 15 , 19 ].…”

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

“…Three studies demonstrated that local anaesthetic wound infiltration reduced pain scores and the need for rescue analgesia during the first 24 h after caesarean section [71][72][73], while one study showed only limited benefits [74]. Apart from one study [72], basic analgesia with ibuprofen and paracetamol was provided.…”

An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

“…7 Use of long acting local anesthetics to reduce pain and promote mobility. 109-112 Utilize surgical techniques to decrease or prevent Jackson Pratt drain use. 113,114 …”

“…125,126 PO food ad lib. Advance as tolerated Postoperative pain medications—opioid reduction protocol (limited narcotics with liposound, bupivacaine, benzodiazepines, and antiemetics, transition to OTCs 110-114,127 TED hose worn until POD 5. SCD use at home while not ambulating.…”