Continuous ropivacaine subfascial wound infusion after cesarean delivery in pain management

OBJECTIVE: The aim of this study is to analyze post-cesarean morphine consumption using continuous ropivacaine subfascial wound infusion.

METHODS: After standardized spinal anesthesia (0.5% hyperbaric bupivacaine 8-10 mg combined with sufentanil 2-2.5 μg), women undergoing cesarean section (n = 69) were randomly allocated to receive either ropivacaine 0.2% (n = 35) or NaCl 0.9% (n = 34) infused through a subfascial wound catheter during 48 h in a multimodal analgesic approach. As primary outcome, opioid use by intravenous patient-controlled analgesia was analyzed. Secondary outcomes were intensity of pain on visual analog scale at rest and at mobilization, postoperative nausea/vomiting, pruritus and time of first ambulation. Independent t test or Mann-Whitney U test, and Pearson's χ2 test or Fisher's exact test were used as appropriate.

RESULTS: Morphine consumption was significantly lower in the ropivacaine group (21.52 ± 21.56 mg) compared with the placebo group (29.57 ± 22.38 mg; 95% confidence interval -18.8 to 2.76; p = 0.047). No significant differences were observed in pain evaluated by visual analog scale, except for pain at mobilization 6 h after surgery (ropivacaine versus placebo: 3.90 ± 2.66 versus 5.36 ± 2.55; p = 0.030). No significant differences were observed in the incidence of postoperative nausea/vomiting, pruritus, and time of first ambulation.

CONCLUSION: Continuous ropivacaine subfascial wound infusion results in less post-cesarean morphine consumption. EudraCT trail registration number: 2017-004797-33. EudraCT link: https://www.clinicaltrialsregister.eu/ctr-search/trial/2017-004797-33/BE#A.