The use of an intraperitoneal wound irrigation system to deliver anaesthesia following caesarean section may be able to reduce the use of post-partum narcotic use, although larger studies are required, researchers reported here at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists (ACOG).
“Control of post-op pain is always important to surgeons,” said Jerome L. Yaklic, MD, Department of Obstetrics and Gynecology, right State University Boonshoft School of Medicine, Dayton, Ohio. “However, there remains considerable concern about the use of narcotics to control this pain. Decreased narcotic use and better pain control can improve maternal bonding and breastfeeding, shorten length of stay, improve patient satisfaction and possibly help address the nation’s opioid epidemic.”
The On-Q wound irrigation system for localised pain control has been studied as a method of reducing morphine use after caesarean delivery, but those studies evaluated its use when placed in the subcutaneous tissue above the fascial plane, the sub-fascial plane, the peritoneal cavity, and above and below the fascia.
The current study is the first to examine dual placement of the catheter at the sub-fascial plane and the uterine incision.
The researchers randomised 50 women who had a caesarean delivery to receive bupivacaine through the On-Q system at the time of wound closure or placebo. Total narcotic use and pain scale scores at 6, 12, 24, and 48 hours postoperatively were used to determine effectiveness. A total of 40 women completed the study, 16 of whom were delivering their first child via caesarean.
There was no significant difference in the use of postpartum narcotic use between groups, or in pain scores, although there was a trend towards reduced pain and narcotic use in the active group at the 6, 12, and 48-hour time points (P < .09).
In addition, women having a repeat caesarean demonstrated an increased use of narcotics, likely related to the increased pain resulting from previous scar tissue or the patient’s previous history with pain after caesarean.
[Presentation title: The Effects of Continuous Local Anesthetic After Cesarean Delivery on Pain and Narcotic Use. Abstract: 22Q]