A randomised controlled trial of the closure or non-closure of peritoneum at caesarean section: effect on post-operative pain (original) (raw)
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Journal of South Asian Federation of Obstetrics and Gynaecology, 2019
Ab s t r Ac t Background: Postoperative pain is one of the major discomforts interfering with baby-care after cesarean section. In our resource-poor hospital setup, we have addressed the issue of impact on postoperative pain, with peritoneal suturing keeping a standardized anesthetic and surgical technique; and postoperative conditions. Aim: To compare postoperative pain intensity after peritoneal closure vs nonclosure during cesarean section. Materials and methods: All total of 140 eligible subjects were allocated over one year into two equal groups as per the randomization list. In the control group, both visceral and parietal peritoneum was closed using absorbable suture; whereas in the study group, both peritoneal layers were left un-sutured. All patients received similar anesthetic and surgical techniques. Postoperative pain assessment was done at regular intervals by a 100 mm visual analog scale (VAS) at rest and on movement. Patient satisfaction was assessed by verbal rating ...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017
Background: Pain is one of the major discomfort which drives post caesarean mothers to seek help. Thus, it is important to know if any change in surgical technique could have effect on the post-operative pain which affects all the woman’s activities. Hence, the study was undertaken to study the effect of closure and non-closure of parietal peritoneum on postoperative pain.Methods: It was a hospital based interventional study done in a tertiary care hospital over one year. Detailed history, investigations, operative details, postoperative outcome in terms of pain were recorded and analysed.Results: Women in the closure group had more postoperative pain. P value was highly significant at 8h (P=0.0001), 16h (P=0.0001), 24h (P=0.00001) and 32h (P=0.000001), 40 hour (P=0.00001) and 48h (P=0.0001).Conclusions: Peritoneal should not be closed routinely in caesarean sections as it is shown to cause less postoperative pain.
Journal of Obstetrics and Gynaecology Research, 2009
Aim: To determine the effect of non-closure of the visceral and parietal peritoneum during cesarean section on short-term postoperative morbidity. Methods: A prospective randomized trial was conducted of 533 women undergoing primary cesarean section; 277 were randomized to closure and 256 to non-closure of the peritoneum. Perioperative outcome measures, such as analgesia dosage and morbidly measures were compared. Results: There was no significant difference between the non-closure and closure groups in the mean number of narcotic analgesia doses (1.09 Ϯ 1.2 vs 1.05 Ϯ 1.0, P = 0.63; respectively), mean number of non-narcotic analgesia doses (4.69 Ϯ 2.7 vs 4.65 Ϯ 2.8, P = 0.89; respectively), number of women with postoperative fever >38°C (18 vs 14, P = 0.37; respectively), number of women with wound infection (29 vs 35, P = 0.54; respectively) and mean number of hospitalization days (4.16 Ϯ 0.91 vs 4.14 Ϯ 0.71, P = 0.78; respectively). Conclusion: Closure or non-closure of the peritoneum at cesarean sections has no significant impact on postoperative analgesic usage and short-term morbidity.
Postoperative Outcome of Caesarean Section in Closure Versus Nonclosure of Parietal Peritoneum
Journal of SAFOG, 2018
Aim: Caesarean section is the commonest obstetric surgery. Any change in the operative technique however small, affects the postoperative outcome.Effect of nonclosure of peritoneum on postoperative outcome was evaluated. Method: This was an interventional study. Postoperative condition of the women was assessed after caesarean section. Peritoneum was either closed or left open and outcome was compared.Statistical analysis was done. Results: Most women in the nonclosure group had earlier ambulation and return of bowel activity and breastfed early in comparison to the closure group. More postoperative pain, nausea and vomiting was observed when peritoneum was closed. Since the stay in hospital was less in women with peritoneal nonclosure and because of use of lesser suture material, this was more cost effective too. Conclusion: Leaving the peritoneal open was a better method than closing it because patient was more comfortable, there was lesser morbidity and shorter hospital stay and cost effectiveness. Clinical significance: The policy of peritoneal nonclosure will help in decreasing maternal discomfort, shorter hospital stay and overall economical.
Closure or Non–Closure of Peritoneum in Cesarean Section: Outcomes of Short-Term Complications
Archives of Trauma Research, 2013
Background: Cesarean section (CS) is one of the most frequently performed surgical procedures worldwide. The complications following a CS include fever, wound infection, post-operative pain and bleeding which are not usually found in a normal vaginal delivery. Traditionally, suturing of peritoneal layers for CS patients has been done, but in some studies it has been shown that this procedure could be eliminated without affecting the rate of morbidity. Objectives: The objective of this study was to assess the short-term outcomes of two different cesarean delivery techniques. Patients and Methods: A total of 100 cases who underwent CS were randomly assigned equally to either closure of both the visceral and parietal peritoneum or no peritoneum closure. Duration of operation, pain scores, analgesic requirements, alterations in hemoglobin levels and febrile morbidity were assessed accordingly. Results: Pain scores, analgesic requirements assessed at 24 hours and operation duration were significantly lower in the non-closure group as compared to the closure group. Febrile conditions and changes in hemoglobin levels were similar in both groups. Conclusions: Non-closure of both visceral and the parietal peritoneum when performing a CS produces a significant reduction in pain, fewer analgesic requirements and a shorter operation duration without increasing the febrile morbidity and changes in hemoglobin levels as compared to the standard methods.
Open Journal of Anesthesiology, 2012
Background: Management of postoperative pain after caesarean section (C/S) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section. Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia versus Conventional Continuous Infusion 121
Patient-controlled versus nurse-controlled post-operative analgesia after caesarean section
Advanced Biomedical Research, 2012
Background: The aim of this study was to compare the differences in the quality of analgesia by patientcontrolled analgesia (PCA) and nurse-controlled analgesia (NCA) for post-caesarean section analgesia. Materials and Methods: 350 women who undertake elective cesarean section were assigned to the three groups. Group I (n=200), IV-PCA morphine; group II (n=100), IV-PCA methadone; group III (n=50) NCA morphine. Data collected during the 24 h observation period included visual analog scale (VAS) pain and patient satisfaction scores, the incidence of nausea and vomiting, severe sedation and pruritis. Results: VAS pain scores for each time at which it was evaluated were higher for NCA group than other groups. Also patient satisfaction was significantly increased in the IV-PCA Group as compared with group III. The prevalence of pruritis was higher for NCA group than other groups. Conclusion: In post caesarean section, PCA morphine or methadone improves 24-h VAS compared with NCA.
Peri-operative multi-modal pain therapy for Caesarean section: analgesia and fitness for discharge
Canadian Journal of Anaesthesia, 1997
To compare, the efficacy of a multi-modal analgesic regimen and single drug therapy with/v PCA morphine after Caesarean delivery with spinal anaesthesia. Mc'~ods: Forty ASA 1-2 parturients presenting for elective Caesarean section were randomized to receive multimodal pain treatment with intrathecal morphine, incisional bupivacaine and ibuprofen + acetaminophen po until hospital discharge (Group I ) or conventional therapy with iv PCA morphine weaned to acetaminophen + codeine po. (Group 2). Both groups received spinal anaesthesia with 1.7 ml hyperbaric bupivacaine 0.75%. Visual analog pain scores at rest (RVAPS) and with movement (DVAPS) were recorded q 2 hr during the first 24 hr, then q 4 hr until discharge. Time to first walking, eating solid food, flatus, bowel movement, voiding and hospital discharge were recorded. Results: Pain scores were lower in Group I patients during the first 24 hr after spinal injection RVAPS 0.6 • 0. I in Group I vs 2. I • 0. I in Group 2 (mean __. SEM), DVAPS 1.9 ___ 0. I in Group I vs 4. I + 0. I in Group 2 (P < 0.0001). Times to first flatus, 36. I hr • 2.9 vs 20.5 +--1.8 (P < 0.05) and to first bowel movement, 74,8 hr • 5.6 vs 57.4 _+ 4.7 (P < 0.0001 ) were longer in Group 2 patients. There was no difference between groups in time to eating solid food, walking or hospital discharge. Concision: Multi-modal pain therapy resulted in improved early post-operative analgesia during the first 24 hr after Caesarean delivery. Patients receiving/v PCA morphine followed by acetaminophen + codeine po were more likely to develop decreased bowel mobility, All patients, with one exception, achieved discharge criteria (eating solid food, absence of nausea, normal lochia, dry incision and DVAPS < 4) at 48 hr after spinal injection.
International Journal of Clinical Trials
Background: Pain management post-caesarean section is a common source of exposure to opioids in women. To address the rising opioid addiction associated with peri-operative administration, trend in operative analgesia is moving towards opioid-free, multimodal analgesia. We present our protocol for this study so that it may be replicated in other settings and possibly modified for future studies.Methods: In a Single-centre, non-inferiority, parallel, randomized, controlled, clinical trial with balanced allocation [1:1] into two arms, we compared a peri-operative opioid-free analgesia regimen with a routine post-operative opioid-based analgesia regimen in women undergoing caesarean section under spinal anaesthesia. Primary outcome measures were post-operative pain intensity at 4, 8 and 24 hours (using Numerical Rating Scale) and post-operative pentazocine use. Secondary outcome measures were the incidence of adverse events and Apgar score. Results will be published in a peer-reviewed,...
Predictors of post-caesarean section pain and analgesic consumption
Journal of Anaesthesiology Clinical Pharmacology, 2011
Background: Background: Ideally, the intensity of postoperative pain should be predicted so as to customize analgesia. The objective of this study was to investigate whether preoperative electrical and pressure pain assessment can predict post-caesarean section pain and analgesic requirement. Materials and Methods: Materials and Methods: A total of 65 subjects scheduled for elective caesarean section, who gave written informed consent, were studied. Preoperatively, PainMatcher ® was used to evaluate electrical pain threshold, while manual PainTest™ FPN 100 Algometer and digital PainTest™ FPX 25 Algometer determined pressure pain threshold and tolerance. Postoperatively, numerical rating scales were used to assess pain at regular time intervals. Patients received intramuscular pethidine (100 mg, 6 hourly), rectal diclofenac (100 mg, 12 hourly), and oral paracetamol (1 g, p.r.n.) for pain relief. Statistical analysis was conducted using PASW Statistics 18 software.