Role of Pre-emptive Local Lidocaine 2% Infiltration in Postoperative Pain Management in Cesarean Delivery Performed under Spinal Anesthesia (Randomized Clinical Trial)

Abstract

Objective:To assess the efficacy of pre-emptive infiltration of Lidocaine 2%in improving pain feeling during postoperative period.Study design:Prospective randomized controlled clinical trial.Study setting: Ain Shams University Maternity Hospital. Patients: 128 patientsundergoing elective cesarean section were randomly allocated to one of the two equal groups of the studywho either received preoperative (4mg/kg) Lidocaine (n=64), or (4mg/kg) saline (n=64) in the subcutaneous layer of anterior abdominal wall, then we evaluated the results. Results:significant reduction in Visual Analogue Scale (VAS) in Lidocaine group compared to saline group in the first 12 hours postoperative. Significant difference also noticed in patient's first analgesic request as Lidocaine (11.71.113) group requested analgesics after control group (3.300.728). significant difference between the two groups as regard the dose of analgesic consumption in twelve hours postoperative as Lidocaine group consumed only (75mg sodium diclofenac), while control group consumed (150mg). significant differences between both groups in the duration needed to remove the urinary catheter with Lidocaine group (5.370.458) while saline group (6.190.794), and the duration needed to start walking after surgery with Lidocaine group (4.061.193) while saline group (4.840.601).No significant difference noticed between both group as regard development of adverse effects as 9 patients out of 64 in each group developed mild subcutaneous oedema after infiltration of Lidocaine (N=64) or saline (N=64). As regard initiation of breast feeding, significant difference was noticed between the two groups, with Lidocaine group (2.420.498) and saline group (3.271.012), Lidocaine group could breast feed their babies faster than saline group.Conclusion: preoperative Lidocaine infiltration superior to placebo in reducing postoperative pain in women undergoing caesarean delivery under spinal anesthesia provided the infiltrated does is adjusted to the patient's weight.Key words: Pre-emptive, lidocaine 2%, Cesarean section, Pain management, Spinal Anesthesia.