POST-CAESAREAN SECTION INCISIONAL INFILTRATION WITH LIDOCAINE VERSUS LIDOCAINE AND EPINEPHRINE; A RANDOMIZED CONTROLLED TRIAL

Abstract

Cesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation (Bamigboye, 2010). The surgical techniques for performing cesarean delivery has changed from time to time, from surgeon to surgeon and these changes were involved both, of the uterine and skin incisions. Only a small number of these techniques have been evaluated in randomized controlled trials (Tully et al., 2002). The progressive increase in the incidence of caesarean birth has been a notable feature of contemporary obstetric practice and caesarean delivery is now the most frequent major surgical procedure performed in obstetrics and gynaecology (Martin et al., 2002). Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (Arthur, 2006). Sufficient control of post-caesarean section pain is imperative to relieve patients’ discomfort, as well as to enhance breast-feeding performance and infant care (Karlstr, 2007). Since the development of lidocaine in 1943, infiltrative local anesthetics have been used for many clinical procedures. Laceration repair, skin biopsies, curettage, and digital blocks are some of the standard procedures that require local infiltrative anesthesia. Even with the recent advances in topical anesthesia, infiltrative anesthesia remains a mainstay for painful office procedures(Suraj, 2002). Today, epinephrine combined with lidocaine is the local anesthetic combination generally judged as giving a clinically optimal effect with respect to anesthesia and homeostasis in all surgical procedures.7-10 The choice of lidocaine in a concentration of 2% is based on historical data obtained from nonsurgical experiments (Rozanski, 1988). It is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices and lack of analgesic regimens that account for inter-individual differences and requirements. Untreated acute pain has the potential to produce acute neuro-humoral changes, neuronal remodeling, and long lasting psychological and emotional distress, and may lead to prolonged chronic pain states (Robert, 2010). Providing effective post-operative analgesia is a key to achieving early mobilization and the surgical rectus sheath block may provide a useful alternative to established regional anesthetic techniques(Crosbie, 2012). The objective of our study was to assess the efficacy and safety of adding ef epinephrine to lidocaine 2% in dose-related manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post-caesarean section pain after general anesthesia. After application of Inclusion criteria: • Women undergoing caesarean delivery under General anesthesia for various indications. • Women refusing spinal anesthesia. And Exclusion Criteria: • Known or had suspected sensitivity to local anesthesia. • Medical disorders induced by pregnancy (Pre-eclamptic toxemia, gestational diabetes mellitus, Hepatic diseases, homeostatic disorder) • Medical disorders aggravated by pregnancy (cardiovascular disease, pulmonary disease, renal disease, neurological disease, metabolic or infectious diseases). • Women who were hemo-dynamically unstable. • Lack of adequate verbal communication.

Atotal number of 145 women planned for elective caesarean section was recruited, 2 groups were randomized with a study group included 70 women received lidocaine 2% and epinephrine in dose-related manner and a control group included 75 women received lidocaine 2% only. The local anesthesia was injected in subcutaneous layer of the skin in every patient according to the group. Post-caesarean section pain was assessed by visual analogue scale after blinding of both patient and nurse(pain observer).