Efficacy of Intraperitoneal Bupivacaine for Post Cesarean Section Analgesia: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

Patients and Methods: This randomized control trial was carried out at Ain Shams University Maternity Hospital on women undergoing cesarean section under spinal anesthesia . 100 women were included and randomized into two equal groups, group A receiving 20 ml 0.25% bupivacaine while group B received 20 ml normal saline , standardized spinal anesthesia was performed with 2 ml of 0.5% hyperbaric bupivacaine and 25 μg fentanyl. At the end of the operation immediately before closure of the parietal peritoneum women received either saline or bupivacaine installation into the peritoneal cavity. The primary outcome was visual analogue score(VAS ) at 6 hours post operative, secondary outcomes were VAS at 4 and 12 hours post operative ,time of onset of patient’s mobility , time of onset of intestinal motility, time of first request of analgesia, total dose of opioid use for break through pain, incidence of nausea and vomiting. Results: VAS scores at 4,6 and 12 hours post operative and opioid consumption were significantly lower in the bupivacaine group than in the normal saline group , also there was a statistically significant difference in the type of pain between the two groups, however there was no statistically significant difference regarding the onset of patient’s mobility , return of bowl movement , the time of first analgesic request, nausea nor vomiting. Conclusion: Intraperitoneal installation of 200 ml 0.25% bupivacaine decreased post cesarean section pain scores and opioid consumption. Further studies assessing different concentrations and doses to identify optimal dose for best results is recommended.