Citation Information :
Saboo V, Biswas D, Naz A, Seal SL, Ray R. Local Infiltration of Bupivacaine along the Incision Line following Cesarean Section reduces Postoperative Pain and Analgesia Requirement: A Double-blinded Randomized Controlled Study. J South Asian Feder Obs Gynae 2022; 14 (5):596-601.
Introduction: Cesarean delivery commonly induces moderate to severe pain lasting for 48 hours. Any form of intervention that leads to improvement in pain relief can positively impact ability to breast feed early. Infiltration of local anesthetics (LAs) into the surgical wound is a simple, safe, and low-cost technique for postoperative analgesia. Systemic side effects seen with central neural blockades are avoided. Analgesic requirements are also reduced. Risks of LA toxicity are very low or negligible.
Aims and objectives: To compare the effect on postoperative analgesia of bupivacaine (BP) infiltration into the incision line vs normal saline (NS) infiltration after cesarean section (CS) by analyzing pain-free interval, pain score, and overall analgesic consumption in first 24 postoperative hours.
Materials and methods: A prospective, double-blinded, randomized controlled study was conducted in the Department of Obstetrics and Gynecology, RG Kar Medical College and Hospital over 1 year including 130 patients undergoing cesarean delivery under spinal anesthesia. Before skin closure, 30 mL 0.25% BP or NS infiltration was infiltrated over incision line (10 mL in rectus sheath; 10 mL for each upper and lower subcutaneous flap). Postoperatively, the patients were evaluated at 2, 4, 6, 12, and 24 hours. Analgesic drugs were considered on pain score above 4 on visual analog scale (VAS). Diclofenac intramuscularly 75 mg was given on the first request and tramadol on second, if VAS was above 4 within 12 hours.
Results: Mean time of first analgesic demand was 274.30 minutes in BP group whereas 149.15 minutes in NS group (p <0.0001). Pain scores (on VAS) were significantly reduced for up to 6 hours postoperatively in BP group as compared to NS group (at 2 hours, p = 0.000 and at 6 hours, p = 0.007). There was no statistical difference in pain scores in two groups beyond 6 hours. In BP group, 58.46% patients required only 75 mg of intramuscular diclofenac and 41.54% patients required 150 mg of diclofenac in two divided doses whereas in NS group; only 23.08% patients had pain control by 75 mg of intramuscular diclofenac and 76.92% required 150 mg (p = 0.0001). In addition to diclofenac, 26.15% patients in NS group required 100 mg of tramadol vs only 7.7% in BP group (p = 0.0101).
Conclusion: Direct infiltration of 0.25% BP along incision line following cesarean delivery under spinal anesthesia prolongs pain-free interval, provides adequate analgesia for 1st few postoperative hours, reducing requirement of systemic analgesic in first 24 postoperative hours with negligible side effects.
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