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