The efficacy of continuous ropivacaine subfascial wound infusion after
caesarean delivery in pain management: a prospective randomized
controlled double-blind study.
Abstract
Objectives Analyze the efficacy in pain management of
continuous ropivacaine subfascial wound infusion after caesarean
delivery. Design Prospective, randomized controlled,
double-blind study. Participants 69 caesarean section patients.
Intervention After standardised spinal anesthesia (8-10 mg of
0.5 % hyperbaric bupivacaine combined with 2-2.5 μg of sufentanil)
patients were randomly allocated: ropivacaine 0.2 % infused through a
subfascial wound catheter (n = 35) or NaCl 0.9 % (n = 34), for 48 hours
combined with recommended multimodal analgesia approach.
Outcomes The primary outcome was the total amount of IV opioid
use by patient-controlled analgesia in the first 48 hours after
caesarean delivery. Secondary outcomes, assessed at regular intervals,
were intensity of pain evaluated by VAS (0-10) at rest and at
mobilisation, the incidence of post-operative nausea/vomiting and
pruritus and time of first ambulation. Results Morphine
consumption was significantly lower (mean ± standard deviation), in the
ropivacaine group (21.52 mg ± 21.56) compared to the placebo group
(29.57 mg ± 22.38; P value = 0.047). No significant differences were
observed in pain evaluated by VAS (mean ± standard deviation), except
for pain at mobilisation 6 hours after surgery (ropivacaine vs. placebo:
3.90 ± 2.66 vs. 5.36 ± 2.55; P value = 0.03). No significant differences
were observed in the incidence of post-operative nausea/vomiting and
pruritus and time of first ambulation. Conclusion Continuous
ropivacaine subfascial wound infusion can be considered as an effective
analgesic method in addition to multimodal analgesia after caesarean
delivery, resulting in less morphine consumption. Trail
registration EudraCT 2017-004797-33 Funding none