Wound Infiltration May Reduce Pain Following Cesarean Delivery

In an article published in JAMA Network Open by Gali Garmi, MD, and his colleagues state that cesarean delivery — commonly referred to as a C-section — is the most common abdominal surgery worldwide. Despite its necessity and potentially life-saving benefits in some situations, cesarian deliveries typically leave the delivering parent in moderate to severe pain. This clinical study aimed to determine if wound infiltration with local anesthetics during delivery can help reduce postoperative pain following a C-section.

According to the publication, the standard treatment for patients experiencing postoperative pain after a cesarean is non-opioid systemic analgesic medication regimens. Despite best efforts to minimize opioid prescription, these non-opioid medications are insufficient in reducing pain. Because pain relief is necessary for bonding with the child, breastfeeding, early ambulation, timely hospital discharge, and patient satisfaction, many providers prescribe opioids for adequate pain relief.

With opioid prescription comes additional risks, such as misuse and addiction. According to the article, “several studies have reported that excessive amounts of opioids are being prescribed to women after cesarean delivery. These agents are associated with numerous adverse effects, and the risk of chronic use after cesarean delivery is of great concern.”

The study conducted by Garmi and his colleagues was a randomized clinical trial conducted between January 25, 2018, and May 30, 2020. Before a scheduled C-section, patients were assigned to the interventional or control group. The interventional group received a single wound infiltration with 15 mL of 1 mg/100 mL adrenaline and 15 mL of 0.5% bupivacaine hydrochloride, while the control group did not receive infiltration.

Researchers found that those in the interventional group were more likely to have a lower visual analogue scale (VAS) score than those in the control group. Two hours post-operation, 15.2% of patients in the control group had a VAS score greater than four, while only 7.7% of those in the interventional group had a VAS score greater than four.

Additionally, 25.5% of women in the control group required opioid analgesics, while only 13.3% of those in the experimental group did. Women in the experimental group reported greater satisfaction than those in the control group despite comparable stay lengths, surgical time, and scar complications.

Researchers in the publication concluded, “due to its efficacy and safety, this technique may be considered as a standard analgesic practice among women undergoing cesarean delivery. In addition, the technique is relatively easy to perform, and the mother–child relationship is not disrupted. Patients who do not receive intrathecal opioids or have general anesthesia for any reason may particularly benefit from this technique.”