Bupivacaine constant continuous surgical wound infusion versus continuous epidural infusion for post cesarean section pain, randomized placebo-controlled study

Background
Cesarean section is considered as one of the most commonly done surgical procedures, which have a rising rate of performance. Postoperative pain may lead to poor patient satisfaction and interfere with early rehabilitation. Increasing evidence is now suggesting that less invasive regional analgesic techniques may be as beneficial as epidural analgesia. This study aimed to compare efficacy, safety and side effect of bupivacaine continuous wound infusion using constant flow PainFusor system with epidural infusion for post-cesarean section analgesia.
Methods
60 patients, ASA physical status I & II, aged 19–42 years, with full-term pregnancy undergoing elective cesarean section were randomly divided into two groups. All patients enrolled in the study performed cesarean section under standardized protocol of general anesthesia. Group A patients received continuous surgical wound infiltration, while group B patients received bupivacaine continuous epidural infusion. Pain was assessed using Visual analogue scale (VAS). Diclofenac sodium 75 mg was administered IM as a rescue analgesic.
Results
The current study showed no significant difference between the two groups in the hemodynamic parameters, respiratory parameters as well as pain scores at rest during the whole period of study. Side effects were statistically non-significant, and only patients who requested analgesia were significantly higher in group A. Furthermore, pain VAS scores on mobilization were significantly lower in group B during the first postoperative day.
Conclusion
The current study demonstrated that bupivacaine administered by continuous epidural infusion provided a significantly lower pain scores with mobilization, and hence better analgesia for post cesarean section pain in the first postoperative day compared to continuous bupivacaine wound infusion through fenestrated catheter using the constant flow PainFusor system.