///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Analgesic Efficacy of Intrawound Infusion of Local Anesthetic after Cesarean Section

Abstract Number: 183
Abstract Type: Meta Analysis/Review of the Literature

Gillian Newman MD, PhD1 ; Jamie Murphy MD2; Christina Khalil BS3; Kerry Blaha MD4; Cristianna Vallera MD5; Christopher Wu MD6

Background: Intrawound infusions of local anesthetics are easy to place and may provide analgesia without the side effects seen with other analgesic agents such as opioids. We examined the analgesic efficacy of intrawound infusions of local anesthetics for postoperative pain management after Cesarean section.

Methods: This project is exempt from the Johns Hopkins IRB. We used the National Library of Medicines Medline database to search for terms related to intrawound infusions of local anesthetics and Cesarean section. Inclusion criteria were randomized controlled trials (RCTs) comparing intrawound infusions of local anesthetics to placebo for postoperative pain after Cesarean section and RCTs published in the English language. Relevant data were abstracted from accepted studies. Meta-analysis was performed using RevMan 4.2.10 (Cochrane Collaboration, 2004). A random effects model was used.

Results: A total of 718 abstracts were obtained from the above search and a total of 5 RCTs met the above inclusion criteria. There was no difference in visual analog pain scores between intrawound infusions of local anesthetics versus placebo at 12-16 h (weighted mean difference [WMD] = -0.85, 95% confidence interval [CI] = -1.92 to 0.23) or at 20-24 h (WMD = 0.11, 95% CI = -0.78 to 1.01) postoperatively. However, use of intrawound infusions of local anesthetics versus placebo was associated with a significantly lower morphine consumption at 24 (WMD = -17.28, 95% CI = -28.08 to -6.49) and 48 (WMD = -20.95, 95% CI = -26.69 to -15.21) hours postoperatively).

Discussion: Compared to placebo, the use of intrawound infusions of local anesthetics did not provide lower pain scores after Cesarean section; however, there was significantly lower morphine consumption up to 48 hours postoperatively. Further RCTs would be useful to determine if this decrease in opioid consumption would result in a decrease in opioid-related side effects or adverse events.

SOAP 2009