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Anesthesia: Essays and Researches

Original Article

Effect of wound infiltration with bupivacaine or lower dose bupivacaine/magnesium versus placebo for postoperative analgesia after cesarean section Ahmad A. Eldaba, Yasser M. Amr, Reda A. Sobhy Department of Anesthesia and Surgical Intensive Care, Tanta University Hospital, Egypt Corresponding author: Dr. Yasser M. Amr, Department of Anesthesia and Surgical Intensive Care, Tanta University Hospital, Tanta University, Tanta 31257, Egypt. E-mail: [email protected]

Abstract Aim: The authors examined the analgesic effect of wound infiltration with bupivacaine or lower dose bupivacaine and magnesium versus normal saline for postoperative analgesia after cesarean section. Materials and Methods: A total of 120 patients,American Society of Anesthesiologists (ASA) I-II were prepared for elective cesarean section.At the end of the surgery, the wound was continuously infiltrated at a rate of 5 ml/h for 24 h post-operatively by one of the following solutions: 0.25% bupivacaine, a mixture of 0.125% bupivacaine and 5% magnesium sulphate or normal saline (0.9%). Total opioid consumption, Visual Analogue Scale (VAS) at rest and movement, incidence of opioid side-effects and signs of wound inflammation were assessed during the period of the study (24 h post-operatively). Three months later, residual pain, surgical wound infection, need for extra-antibiotic therapy and wound healing impairment were assessed. Results: Post-operative pain scores at rest were statistically significant higher in the control group than those in the both wound infiltration groups from 4th h and onwards (P < 0.0001). Meanwhile, post-operative pain was higher in bupivacaine group versus magnesium group (P < 0.0001, P < 0.0001, 0.0012, respectively). There was statistically significant increase in VAS during movement in the control group versus others at 2, 4, 12, 24 h post-operatively (P < 0.0001). However, patients received magnesium plus bupivacaine wound infiltration showed a significant decrease in post-operative pain scores than whom received bupivacaine from 4th h and onward (P < 0.0001, 0.0054, 0.0001, respectively). Morphine consumption was significantly reduced in the magnesium group, (P < 0.0001). Incidence of residual pain was comparable in the three groups. The incidence of sedation and urine retention were noted to be significantly higher in the control group in comparison to other groups, ( P 3 at any time 500 mg of Paracetamol was infused intravenously • Incidence of nausea and vomiting (if occurring ondansetron 4 mg intravenous was given) • Sedation (according to Ramsay’scale). 337

Anesthesia: Essays and Researches; 7(3); Sep-Dec 2013

Eldaba, et al.: Magnesium sulphate for continuous wound infiltration

Incidence of retention of urine (urinary catheter was removed at the end of surgery and retention was defined as the need for catheter during 1st 24 h post-operatively.

rest were statistically significant higher in the control group than those in the both wound infiltration groups from 4th h and onwards (P < 0.0001). Meanwhile, post-operative pain was higher in bupivacaine group versus magnesium group (P < 0.0001, P < 0.0001, 0.0012, respectively). Regarding post-operative pain at movement, there was statistically significant increase in VAS in the control group versus others at 2, 4, 12, 24 h post-operatively (P < 0.0001). However, patients received magnesium plus bupivacaine wound infiltration showed a significant decrease in post-operative pain scores than whom received bupivacaine from 4th h and onward (P value were 0.0782,