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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ผกาพร ชมภูใบ
กริช นนทวาสี
ประสงค์ จตุรศรีวิไล
เสกสรรค์ แซ่แต้


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.


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ชมภูใบ ผ., นนทวาสี ก., จตุรศรีวิไล ป., & แซ่แต้ เ. (2016). Analgesic Efficacy of Pfannenstiel Wound Infiltration following Cesarean Section: Comparison between 0.25% Bupivacaine and Mixture of 0.25% Bupivacaine with Lidocaine. Lampang Medical Journal, 37(2), 46–56. Retrieved from
Original Article


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