Analgesic Efficacy of Pfannenstiel Wound Infiltration following Cesarean Section: Comparison between 0.25% Bupivacaine and Mixture of 0.25% Bupivacaine with Lidocaine
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Abstract
Background: Evidence on the effectiveness of local wound infiltration for cesarean section are conflicting.
Objective: To assess the efficiency of local anesthetic infiltration (bupivacaine with and without lidocaine) to multiple layers of abdominal wall on postoperative pain and chronic pain following cesarean section.
Material and method: A prospective, randomized, double-blinded, placebo-controlled study was conducted on 120 parturient women underwent elective cesarean section under general anesthesia. They were allocated into 3 groups for receiving the following drug; group BL: mixture of 0.5% bupivacaine 20 ml and 1% lidocaine 20 ml, group B: 0.25% bupivacaine 40 ml, and group NSS: 0.9% NaCl 40 ml; infiltrated to peritoneum(10 ml), below rectus sheath (10 ml)
and subcutaneous (20 ml) before wound closure. Two doses of intramuscular diclofenac and intravenous morphine patient controlled analgesia were administered postoperatively for 24 hours.
Results: Postoperative pain score at rest in group B was higher than group BL and NSS (p=0.030). No significant differences in pain score on movement and 24-hours morphine consumption were found among three groups (p=0.091 and p=0.672). Time to maximum pain in group BL and B were significantly longer than group NSS (7.5±8.1 vs 6.4±7.8 vs 4.0±6.0 hours, p=0.037). Satisfaction and side effects were comparable in three groups. Postsurgical pain syndrome at 3
months were found in group BL 19.2%, group B 14.8% and group NSS 30.8% (p=0.381).
Conclusion: Multilayer infiltration technique of bupivacaine with and without lidocaine to Pfannenstiel incision did not decrease pain score or morphine consumption. However, it prolonged the time to maximum pain in postoperative period. Local anesthetic injection did not prevent postsurgical pain syndrome.
Article Details
บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
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