Evaluation of the Effectiveness of Using Intraperitoneal Lidocaine in PostCesarean Pain Decrease

سال انتشار: 1398
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 387

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شناسه ملی سند علمی:

COBGY15_055

تاریخ نمایه سازی: 11 آبان 1398

چکیده مقاله:

Objective: Women usually suffer from postcesarean pain. The objective of this study is to evaluate the effects of intraperitoneal instillation of lidocaine on postcesarean pain in patients with parietal peritoneal closure.Methods & Materials: After getting informed consent, we enrolled 18-45 years old women with term singleton pregnancies and BMI < 40 (kg/m2) scheduled for elective cesarean delivery under spinal anesthesia. Spinal anesthesia was performed with 0.75% hyperbaric bupivacaine, fentanyl, and morphine. In all cases, surgery was performed through a Pfannenstiel incision. After delivery of the neonate and placenta, uterine closure was completed, with or without exteriorization of the uterus, and blood accumulating into the pelvis was carefully wiped with surgical towels to leave a relatively dry pelvis. At the end of the cesarean delivery, immediately before parietal peritoneum or fascia closure, patients were randomized to receive either lidocaine (20 mL 2% lidocaine with epinephrine) or placebo (20 mL normal saline) instilled into the peritoneal cavity.Effective factors in VAS score such as duration of surgery, adhesion, previous surgery history, level of anxiety were attended.In the postoperative period, pain assessment was carried out by VAS and duration of analgesia was calculated as the time taken from the onset of sensory block to the first request for supplemental analgesia. Haemodynamics and side effects were also recorded in all patients.The primary outcome was pain score on at 24 hours. Secondary outcomes were pain score at 6, 12, and 24 hours; maternal satisfaction score; analgesic consumption; incidence of nausea, vomiting, and itching; and return of bowel function.Results: 185 women were recruited. The average age was 29.13y, BMI 29.39, timespan of previous cesarean 4.7 y, total duration of surgery 42 minutes. The average pain experienced by patients in 6, 12 and 24 hours was 5.3, 4.7 and 3.1. There was no significant difference between two groups in terms of age, education, BMI, disease, drug usage, previous cesarean ethology, drug and alcohol abuse, smoking, anxiety and depression, duration of surgery, bleeding rate during surgery, hematocrit decay, nausea & vomiting and itching.Pain at 6, 12, 24 hours postcesarean delivery was significantly different between both study groups. The average of pain at 6 hours postcesarean was 6.96 in group A and 3.7 in group B (P<0.001). The average of pain at 12 hours postcesarean was 5.41 in group A and 4.04 in group B (P<0.001). The average of pain at 24 hours postcesarean was 3.5 in group A and 2.7 in group B (P=0.007).Petedin and acetaminophen usages for breakthrough pain were significantly different between the lidocaine and placebo groups (P=0.035 and P=0.005 respectively). Also the total amount of required diclofenac was significantly lower in lidocaine in compared with placebo group (P<0.001).The total amount of diclofenac was equal in both groups, but the time of first request of diclofenac in placebo group(4.7 hours) was earlier in compared with lidocaine group (7.1 hours) (P<0.007).Conclusion: 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. Also no considerable side effect was observed.

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نویسندگان

Fatemeh Tara

Fellowship of perinatology- Mashhad university of medical sciences- Mashhad- Iran

Somayeh Moein Darbari

Fellowship of perinatology- Mashhad university of medical sciences- Mashhad- Iran