A COMPARISON BETWEEN LIDOCAINE-PRILOCAINE (EMLA) CREAM APPLICATION AND WOUND INFILTERATION WITH LIDOCAINE FOR POST-CESAREAN SECTION PAIN RELIEF: A RANDOMIZED CONTROLLED TRIAL

Abstract

Summary P ost-cesarean section pain is an important issue in obstetrics. Large amounts of opioid analgesic drugs are often required in the management of intense post-operative pain, as this option is associated with many side effects, including evident disruption of mother/newborn bonding. Local anesthetics either on their own or in combination with opioids or non-steroidal anti-inflammatory drugs have been employed as an adjunct to other post-operative pain relief strategies. The aim of study is to compare the efficacy of topically applied lidocaine-prilocaine (EMLA) cream with local anesthetic (lidocaine) infiltration on post-cesarean section pain relief, the total amount of pethidine consumption, first time request analgesia, ambulation time, complication and wound infection rate. Eighty healthy pregnant full term women, going to have cesarean section. all patients had cesarean section under bupivacaine spinal anesthesia and patient received post – operative analgesia in form of NSAID (diclofenac sodium 75mg IM every 12 hours). Additional analgesia on demand in the form of i.v. pethidine, was given according to visual analogue scale value. Pain assessed 30 minutes after skin closure using a 100 point visual analogue scale (VAS) which was continued in the ward after 30 min, 1 , 2 , 4 , 6 , 8 , 12 , 24 hours. Post- operatively, the total amount of pethidine consumed after 24 hours was calculated, onset of ambulation and onset and duration of breastfeeding was recorded. They have been randomized into two groups:- Group A (EMLA group):- n=40 women Application of 10 gm dose (2 tubes) of lidocaine-prilocaine cream (EMLA cream) as a thick layer (1.5-2g per 10cm²) to the surgical incision after its closure and the area was covered by an occlusive adhesive dressing to facilitate penetration through the skin. Group B (Lidocaine group):- n=40 women The wound was infiltrated after its closure, with 20 ml of 1% lidocaine in skin and subcutaneous tissue. The presented study revealed that: The topical application of lidocaine-prilocaine (EMLA) cream to the surgical wound of cesarean section after spinal anesthesia, provides effective analgesia comparable to infiltration with 1% lidocaine for several hours, decreases systemic opioid (pethidine) consumption, decreases patients ambulation time and prolongs first time request analgesia.