A prospective, randomized, double-blind trial was conducted to assess contribution to postoperative
analgesia of intermittent instillation of 0.25%
bupivacaine beneath the rectus sheath in 70 women delivered by lower uterine segment
Caesarean section. The operations were performed via a Pfannenstiel incision under spinal anaesthesia. Background intravenous
narcotic analgesia was provided with a
patient controlled analgesia system (PCAS) using a standard
morphine regimen. Overall (44 hr) mean
morphine consumption was significantly greater in the placebo (saline) group compared to the treatment group (84.2 mg versus 63.3 mg. Two tailed t test p < 0.001). The most significant intergroup differences in
narcotic use were found in the first 4 hours and between 24 and 36 hours after commencing PCAS (Two tailed t test p = 0.014 and 0.003 respectively). Subjective
pain scores were assessed with
a 10 cm visual analogue scale (VAS). The mean peak VAS score was greater in controls (5.37) than the treatment group (4.25) between 18 and 24 hours postoperatively (Mann-Whitney U = 424, p = 0.027). There were no intergroup differences in
pain scores for any other time period. The overall incidence of
nausea was lower in the treatment group compared to the control group (Chi squared with Yates' correction p = 0.046) and a lower degree of sedation was seen in those receiving
bupivacaine between 4 and 8 hours after commencing PCAS (Mann-Whitney U = 427, p = 0.028). No differences in other
narcotic related side-effects (
vomiting and
pruritus) were shown between groups. Regular instillation of 0.25%
bupivacaine beneath the rectus sheath of women delivered by
Caesarean section reduces their
morphine requirements by 25% in the 44 hours after operation, with an associated reduction in both
nausea and early sedation.