Effect of high-volume systematic local infiltration analgesia in Caesarean section: a randomised, placebo-controlled trial

Klaus Richter Larsen; B B Kristensen; M A Rasmussen; Y H Rasmussen; T. Weber; B Kristensen; H Kehlet

doi:10.1111/aas.12509

Effect of high-volume systematic local infiltration analgesia in Caesarean section: a randomised, placebo-controlled trial

Klaus Richter Larsen, B B Kristensen, M A Rasmussen, Y H Rasmussen, T. Weber, B Kristensen, H Kehlet

Department of Clinical Medicine

13 Citations (Scopus)

Abstract

BACKGROUND: Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined.

METHODS: Ninety patients scheduled for elective Caesarean section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation.

RESULTS: No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared with the placebo group (P = 0.0493). The administration of ketobemidone at 24 h post-operatively in the ropivacaine 0.5% group was reduced compared with the placebo group (P = 0.020), and between the ropivacaine 0.2% group and the ropivacaine 0.5% group (P = 0.044). No significant differences between groups were found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed.

CONCLUSIONS: Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed no significant effect on post-operative pain intensity. However, a statistically significant, but clinically limited opioid sparing effect was demonstrated compared with placebo in the high concentration, low volume group.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	59
Issue number	5
Pages (from-to)	632-9
Number of pages	8
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.12509
Publication status	Published - 1 May 2015

Keywords

Adult
Amides
Analgesia, Obstetrical
Analgesics, Opioid
Anesthesia, Local
Anesthetics, Local
Cesarean Section
Double-Blind Method
Endpoint Determination
Female
Humans
Infant, Newborn
Pain Measurement
Pain, Postoperative
Postoperative Nausea and Vomiting
Pregnancy
Sufentanil

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@article{17a02fc6cda04be2a0cf8e55f26786da,

title = "Effect of high-volume systematic local infiltration analgesia in Caesarean section: a randomised, placebo-controlled trial",

abstract = "BACKGROUND: Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined.METHODS: Ninety patients scheduled for elective Caesarean section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation.RESULTS: No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared with the placebo group (P = 0.0493). The administration of ketobemidone at 24 h post-operatively in the ropivacaine 0.5% group was reduced compared with the placebo group (P = 0.020), and between the ropivacaine 0.2% group and the ropivacaine 0.5% group (P = 0.044). No significant differences between groups were found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed.CONCLUSIONS: Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed no significant effect on post-operative pain intensity. However, a statistically significant, but clinically limited opioid sparing effect was demonstrated compared with placebo in the high concentration, low volume group.",

keywords = "Adult, Amides, Analgesia, Obstetrical, Analgesics, Opioid, Anesthesia, Local, Anesthetics, Local, Cesarean Section, Double-Blind Method, Endpoint Determination, Female, Humans, Infant, Newborn, Pain Measurement, Pain, Postoperative, Postoperative Nausea and Vomiting, Pregnancy, Sufentanil",

author = "Larsen, {Klaus Richter} and Kristensen, {B B} and Rasmussen, {M A} and Rasmussen, {Y H} and T. Weber and B Kristensen and H Kehlet",

note = "{\textcopyright} 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",

year = "2015",

month = may,

day = "1",

doi = "10.1111/aas.12509",

language = "English",

volume = "59",

pages = "632--9",

journal = "Acta Anaesthesiologica Scandinavica",

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TY - JOUR

T1 - Effect of high-volume systematic local infiltration analgesia in Caesarean section

T2 - a randomised, placebo-controlled trial

AU - Larsen, Klaus Richter

AU - Kristensen, B B

AU - Rasmussen, M A

AU - Rasmussen, Y H

AU - Weber, T.

AU - Kristensen, B

AU - Kehlet, H

PY - 2015/5/1

Y1 - 2015/5/1

N2 - BACKGROUND: Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined.METHODS: Ninety patients scheduled for elective Caesarean section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation.RESULTS: No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared with the placebo group (P = 0.0493). The administration of ketobemidone at 24 h post-operatively in the ropivacaine 0.5% group was reduced compared with the placebo group (P = 0.020), and between the ropivacaine 0.2% group and the ropivacaine 0.5% group (P = 0.044). No significant differences between groups were found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed.CONCLUSIONS: Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed no significant effect on post-operative pain intensity. However, a statistically significant, but clinically limited opioid sparing effect was demonstrated compared with placebo in the high concentration, low volume group.

AB - BACKGROUND: Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined.METHODS: Ninety patients scheduled for elective Caesarean section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation.RESULTS: No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared with the placebo group (P = 0.0493). The administration of ketobemidone at 24 h post-operatively in the ropivacaine 0.5% group was reduced compared with the placebo group (P = 0.020), and between the ropivacaine 0.2% group and the ropivacaine 0.5% group (P = 0.044). No significant differences between groups were found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed.CONCLUSIONS: Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed no significant effect on post-operative pain intensity. However, a statistically significant, but clinically limited opioid sparing effect was demonstrated compared with placebo in the high concentration, low volume group.

KW - Adult

KW - Amides

KW - Analgesia, Obstetrical

KW - Analgesics, Opioid

KW - Anesthesia, Local

KW - Anesthetics, Local

KW - Cesarean Section

KW - Double-Blind Method

KW - Endpoint Determination

KW - Female

KW - Humans

KW - Infant, Newborn

KW - Pain Measurement

KW - Pain, Postoperative

KW - Postoperative Nausea and Vomiting

KW - Pregnancy

KW - Sufentanil

U2 - 10.1111/aas.12509

DO - 10.1111/aas.12509

M3 - Journal article

C2 - 25786811

SN - 0001-5172

VL - 59

SP - 632

EP - 639

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 5

ER -

Effect of high-volume systematic local infiltration analgesia in Caesarean section: a randomised, placebo-controlled trial

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Keywords

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