Abstract | BACKGROUND: Cesarean delivery is a commonly performed procedure worldwide. Despite improvements in balanced multimodal analgesia, there remains a proportion of women for whom postoperative pain relief and patient satisfaction are still inadequate. Intraperitoneal instillation of local anesthetic has been shown to be effective in reducing postoperative pain after abdominal surgery. We sought to investigate the effect of intraperitoneal instillation of lidocaine on postcesarean delivery pain as part of a multimodal analgesia regimen. METHODS: RESULTS: Two hundred four women were recruited. Baseline characteristics were similar between the lidocaine and placebo groups. Pain scores at 24 hours postcesarean delivery on movement (parameter estimate 0.02 [95% confidence interval {CI} -0.14 to 0.18]; P = .823) and at rest (parameter estimate 0.00 [95% CI -0.32 to 0.33]; P = .986) were similar in both groups. Pain scores at 2 hours postcesarean delivery on movement (parameter estimate -0.58 [95% CI -0.90 to -0.26]; P = .001) and at rest (parameter estimate -1.00 [95% CI -1.57 to -0.43]; P = .001) were lower in the lidocaine group. Subgroup analysis of patients with peritoneum closure revealed significantly lower pain scores at 24 hours on movement (parameter estimate -0.33 [95% CI -0.64 to -0.03]; P = .032) in the lidocaine group. The number of women requesting postoperative opioids for breakthrough pain was significantly lower in the lidocaine group compared with that of the placebo (40 [40%] vs 61 [65%], respectively, relative risk 0.59 [95% CI 0.43-0.81]; P = 0.001). CONCLUSIONS: The use of intraperitoneal instillation of lidocaine improves early postoperative pain management after cesarean delivery. Furthermore, it reduces the number of women requesting systemic opioids in the immediate postpartum period. Women undergoing peritoneal closure may particularly benefit from this intervention.
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Authors | Ruchira Patel, Jose C A Carvalho, Kristi Downey, Marcelo Kanczuk, Paul Bernstein, Naveed Siddiqui |
Journal | Anesthesia and analgesia
(Anesth Analg)
Vol. 124
Issue 2
Pg. 554-559
(02 2017)
ISSN: 1526-7598 [Electronic] United States |
PMID | 27984226
(Publication Type: Journal Article, Randomized Controlled Trial)
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Chemical References |
- Anesthetics, Intravenous
- Anesthetics, Local
- Morphine
- Lidocaine
- Fentanyl
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Topics |
- Adult
- Anesthesia, Spinal
- Anesthetics, Intravenous
- Anesthetics, Local
(administration & dosage, therapeutic use)
- Cesarean Section
(methods)
- Double-Blind Method
- Female
- Fentanyl
(administration & dosage)
- Humans
- Injections, Intraperitoneal
- Lidocaine
(administration & dosage, therapeutic use)
- Morphine
(administration & dosage)
- Pain Measurement
- Pain, Postoperative
(prevention & control)
- Postoperative Nausea and Vomiting
(epidemiology)
- Pregnancy
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