INTRAPERITONEAL INSTILLATION VERSUS WOUND INFILTRATION FOR POSTOPERATIVE PAIN RELIEF AFTER CAESAREAN SECTION

Abstract

Abstract

Background: Severe acute pain following caesarean section is a risk factor for chronic pain and postpartum depression necessitating opioids for analgesia. Objective: To compare the intraperitoneal instillation and local wound infiltration of anaesthetic agent for analgesia after caesarean section under spinal anaesthesia. Methods: This prospective, randomized, double-blind, placebo-controlled trail was conducted in the Department of Obstetrics and Gynaecology, Rajarajeswari Medical College and Hospital, Bangalore among women undergoing elective caesarean section via Pfannenstiel incision under spinal anaesthesia. The minimum estimated sample size was 23 participants in each group – Group 1, local anaesthetic wound infiltration group (LWI); Group 2, intraperitoneal local anaesthetic (IPLA) instillation group; and Group 3, placebo group. Results: The present study included a total of 69 participants – 23 in each group. The baseline characteristics of the participants (age (in years), weight (in kg), height (in metres), body mass index (in kg/m2), gestational age (in weeks), and duration of operation (in minutes)) did not vary significantly between the study group (p>0.05) – reducing the potential for confounding variables, which can distort study results. The mean (SD) visual analogue scale (VAS) scores assessed at rest did not vary significantly (p>0.05) between the study groups (1, 2 and 3) at 2 hours (10.9 (8.6) vs 12.6 (9.3) vs 13.1 (10.2)), 12 hours (20.3 (11.2) vs 22.8 (10.4) vs 24.3 (12.8)), and 24 hours (27.5 (13.2) vs 29.4 (14.6) vs 30.2 (15.7)); however, the scores progressively increased in all the groups. The mean (SD) VAS scores at movement was significantly lower in group 1 (LWI; 11.2 (7.3)) in comparison with group 2 (IPLA; 14.7 (12.3)) and group 3 (placebo; 17.2 (8.6)) (p<0.05) at 2 hours. However, the mean (SD) scores did not vary significantly at movement between the study group at 12 and 24 hours. Conclusion: The use of local wound infiltration of anaesthetic agent reduces early pain scores on movement in women undergoing caesarean section under spinal anaesthesia.