Single Infiltration of wound with bupivacaine and adrenaline during cesarean reduces Postoperative pain: JAMA

A new study conducted by Gali Garmi and team shows that during a cesarean birth, wound infiltration with a single dose of bupivacaine and adrenaline decreased postoperative pain and opioid usage and may have increased mother satisfaction with pain control.

The findings of this study were published in the Journal of American Medical Association.

After a cesarean birth, the majority of women suffer moderate to severe pain. Uncertainty exists over the effectiveness of surgical wound infiltration with local anesthetic drugs during cesarean birth in reducing postoperative pain. In order to reduce postoperative discomfort following cesarean birth, this research was done to test the effectiveness of single wound infiltration with bupivacaine and adrenaline.

Between January 25, 2018, and May 30, 2020, this randomized clinical study was carried out in an Israeli university teaching hospital in Afula. A total of 288 singleton pregnant women who were scheduled for planned cesarean deliveries at term were randomly assigned to either get single wound infiltration with bupivacaine and adrenaline (intervention group) or not at all (control group) during cesarean deliveries. Before the incision was closed in the intervention group, the subcutaneous layer was infiltrated on both sides of the wound with a solution of bupivacaine and adrenaline. The groups shared comparable perioperative procedures in other areas. A visual analog scale (VAS) score ranging from 0 to 10 was used to measure mean pain intensity over the course of 24 hours following surgery as the primary outcome.

The key findings of this study were:

1. 143 women from a group of 288 were randomly assigned to the intervention group, and 145 to the control group.

2. The obstetric and demographic characteristics were comparable between the groups.

3. When compared to the control group, the primary outcome (VAS pain score) was considerably lower in the intervention group.

4. Compared to 22 women (15.2%) in the control group, 11 women (7.7%) in the intervention group had a VAS score greater than 4 at 2 hours.

5. Additionally, the intervention group reported considerably decreased postpartum usage of rescue opioid analgesics and higher satisfaction with pain management compared to the control group.

6. The duration of the procedure, scar problems (infection, hematoma, or separation), and duration of stay were comparable between the intervention and control groups.

In conclusion, this method may be regarded as standard analgesic therapy among women having a cesarean birth because of its effectiveness and safety. The mother-child bond is not harmed, and the approach is also rather simple to use. This method may be especially helpful for patients who do not receive intrathecal opioids or who are under general anesthesia for any reason.

Reference:

Garmi, G., Parasol, M., Zafran, N., Rudin, M., Romano, S., & Salim, R. (2022). Efficacy of Single Wound Infiltration With Bupivacaine and Adrenaline During Cesarean Delivery for Reduction of Postoperative Pain. In JAMA Network Open (Vol. 5, Issue 11, p. e2242203). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.42203