Effect of Rectus Muscle Re-approximation and Postoperative Pain in Women with Previous Cesarean Delivery: A Randomized Controlled Trial

Abstract

C esarean section rate has increased dramatically worldwide but there is still debate about the optimum operative technique of cesarean section. Rectus muscle reapproximation at cesarean delivery (CD) is performed frequently by some obstetricians; however, the effect on postoperative pain is unclear. To this end, we investigated whether rectus muscle reapproximation increases postoperative pain. This study was a prospective, double-blind, randomized controlled trial. It included 340 women with previous cesarean delivery, with a singleton pregnancy, who underwent elective lower segment cesarean section at term. The patients were randomly allocated into two equal groups; Group I (study group) in which rectus muscle approximation were done (surgeons were instructed to place three vertical midline loose interrupted sutures to re-approximate the rectus muscles by using Vicryl 0 suture) while in Group II (control group) rectus muscle approximation not done. Intra- and postoperative pain management was standardized within the study protocol. The primary outcome was post-operative pain assessment. The pain was measured by (NPS) Numerical pain score. Operative time in minutes, any post-operative complications and length of hospital stay were also assessed.