Comparison of the Efficacy of Postcesarean Analgesia

Comparison of the Efficacy of Postcesarean Analgesia by Combination of Intraperitoneal Instillation of Local Anaesthetics with Infiltration Through the Wound Site Versus Intratechal Morphine

Aim is to evaluate the efficacy of anaesthetic instillation on peritoneum in combination with infiltration through all of the anterior abdominal structures in comparison to intrathecal morphine for post-cesarean analgesia.

46 women scheduled for elective cesarean-section under spinal anaesthesia were randomly allocated into two groups. Spinal anaesthesia in Group II was performed using isobaric 0,5% bupivacaine + 15µg fentanyl considering the height and weight, while in Group I 150µg morphine was also added. At the end of the surgery in Group II, a solution of 15 ml 0,5% bupivacaine + 15 ml 2% lidocaine+1:200.000 epinephrine was instilled on four quadrants of uterus, infiltrated on borders of the rectus aponeurosis and through the wound site. In group I, same volumes of saline were administered instead. Primary outcome was the total opioid consumption in the first 24 hours postoperatively. Secondary outcomes were pain scores at rest and during movement at; 2,4,6,12,24. hours, incidence of adverse effects and the time for first opioid request. (NCT05405049)

Demographic data except for height (p=0.23) and total opioid consumption (p=0.075) were similar amongst groups. Time for first opioid request was significantly longer in Group I. (p=0.034). No statistically significant difference was found between groups considering active and passive pain scores and adverse effects except for pruritus(p=0.032) .

Combining intraperitoneal local anaesthetic instillation and infiltration through anterior abdominal structures provides post-cesarean analgesia as effectively as intratechal morphine. This combination is non-inferior and can be an alternative to intratechal morphine in cases where it is not possible.