The Analgesic Efficacy of Para-incisional Infiltration With Bupivacaine for Parturients Undergoing Cesarean Section Under Spinal Anesthesia in University of Gondar Specialized Hospital, Northwest Ethiopia

Abstract

Abstract Background: Cesarean section commonly induces moderate to severe pain for 48 hours postoperatively with 11.8% incidence of chronic pain. Adequate analgesia is mandatory to protect the peri-operative complications of pain. For this purpose there are different options of post cesarean section pain management modality. Para-incisional infiltration is an easy type of pain management with different controversies of its efficacy. Objective: This study was performed to investigate the efficacy of para-incisional infiltration with bupivacaine after cesarean section under spinal anesthesia for the first 24 post-operative hours at University of Gondar Specialized hospital, Ethiopia. Methods: Institutional based prospective cohort study was conducted on ASAI and ASAII parturient underwent cesarean section under spinal anesthesia from March to May 2018. A total of 108 parturients (54 for each infiltrated and control groups) were included by convenience sampling technique. Post-operative pain severity using NRS at rest and on movement/cough, total analgesic consumption within 24hrs and time to first analgesia request was recorded and the data was analyzed using SPSS version 20. Result: Compared to the control group, para-incisional infiltration with bupivacaine after cesarean section under spinal anesthesia reduced post-operative pain numerical rating scale significantly at rest and on movement at the first 4thand 6th hours. It reduced total tramadol consumption significantly within the first 24hrs (50 (50-100) mg versus 50 (0-50) mg; p < 0.001). Time to first analgesic request was significantly prolonged in the infiltrated group when compared with the control group (480 (360-720) min versus 240 (240-270) min, p<0.001). Conclusion and recommendation: Para-insisional infiltration with bupivacaine is an effective and easy way of post cesarean section pain management modality for the first 6 post-operative hours. Therefore we recommend that para-insisional skin infiltration after cesarean section as a component of multimodal analgesia