Ropivacaine abdominal wound infiltration and peritoneal spraying at cesarean delivery for preemptive analgesia.

Author(s): Bamigboye AA, Justus HG

Affiliation(s): Nelspruit Medi-Clinic Hospital, Nelspruit, South Africa; Department of Obstetrics and Gynecology, University of the Witwatersrand, Johannesburg, South Africa.

Publication date & source: 2008-08, Int J Gynaecol Obstet., 102(2):160-4. Epub 2008 Jun 9.

Publication type:

OBJECTIVE: To determine whether ropivacaine infiltration into all layers of the abdominal cesarean wound and spraying of the peritoneum decreases postoperative pain. METHODS: A randomized controlled trial of women undergoing cesarean delivery under general anesthetic allocated to receive either 30 mL of 0.75% ropivacaine or 30 mL of saline into the wound, including spraying of the peritoneum. Postoperative pain and need for rescue opioids were assessed. RESULTS: Of the 50 women in the ropivacaine group, 24 (48%) required pethidine or experienced severe pain within 1 hour postoperatively compared with 47 (94%) of 50 women in the control group (relative risk 0.51, 95% CI, 0.38-0.69). The amount of pethidine used in the first hour was reduced in the ropivacaine group (mean difference -58, 95% CI, -73.53 to -42.40). Use of diclofenac and tramadol/paracetamol was also reduced in the ropivacaine group. CONCLUSION: Ropivacaine wound infiltration and peritoneal spraying during cesarean delivery under general anesthetic reduces severe pain and need for opioids.