The Effects of Continuous Local Anesthetic After Cesarean Delivery on Pain and Narcotic Use [22Q]

Abstract

INTRODUCTION: Studies of the effectiveness of continuous local anesthetic administration for pain reduction after Cesarean delivery have provided inconsistent results. This study evaluated the effectiveness of this mode of administration on post-surgical pain and narcotic use. METHODS: Fifty women who had a Cesarean delivery were enrolled into a randomized double-blind, placebo controlled trial. The On-Q continuous abdominal wall and intraperitoneal wound irrigation system for local anesthetic administration was placed at the time of closure. Total post-operative narcotic use and patient reported pain scale scores were used to evaluate efficacy of treatment at 6, 12, 24 and 48 hours postoperatively. RESULTS: Forty patients completed the study. Repeated measures ANOVA revealed no significant difference in narcotic use or reported pain scores between the control group and those receiving local anesthetic for all time points. There was a trend towards reduced pain and narcotic use in the study group at the 6, 12, and 48-hour time points (group*time interaction p < 0.09). Regardless of group assignment, women who had a prior Cesarean section, versus primigravid women, had an increased total narcotic use (58.06 mg vs. 38.28 mg, respectively; p < 0.03). CONCLUSION: Dual catheter placement and infusion of bupivacaine has potential to decrease the use of narcotics and pain following Cesarean delivery; however, given the small sample size of the study, a significant difference between groups could not be delineated. Further study is indicated to investigate catheter placement and effects on pain control, narcotic use and other potential benefits such as shorter length of stay.