Get access

Intraoperative injection of bupivacaine-adrenaline close to the fascia reduces morphine requirements after cesarean section: a randomized controlled trial

Authors

  • BOEL NIKLASSON,

    1. Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm
    2. Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm
    Search for more papers by this author
  • ASTRID BÖRJESSON,

    1. Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm
    Search for more papers by this author
  • ULLA-BRITT CARMNES,

    1. Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm
    Search for more papers by this author
  • MÄRTA SEGERDAHL,

    1. Department of Physiology and Pharmacology, Karolinska Institute, Stockholm
    Search for more papers by this author
  • SUSANNE GEORGSSON ÖHMAN,

    1. Sophiahemmet University College, Stockholm
    2. Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
    Search for more papers by this author
  • AGNETA BLANCK

    1. Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm
    2. Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm
    Search for more papers by this author

  • Conflict of interest M.S. is an employee at AstraZeneca who manufactures the local anesthetic used for subcutaneous injection. No financial support for the study was received from Astra Zeneca. No potential conflicts of interest could be identified for any of the other authors.

  • Please cite this article as: Niklasson B, Börjesson A, Carmnes U-B, Segerdahl M, Öhman SG, Blanck A. Intraoperative injection of bupivacaine-adrenaline close to the fascia reduces morphine requirements after cesarean section: a randomized controlled trial. Acta Obstet Gynecol Scand. 2012; 91:DOI: 10.1111/j.1600-0412.2012.01480.x.

Boel Niklasson, Department of Obstetrics and Gynecology, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden. E-mail: boel.niklasson@ki.se

Abstract

Objective. The purpose of this study was to investigate whether a single injection of bupivacaine with adrenaline close to the fascia could decrease opiate consumption and pain in patients undergoing cesarean section in spinal anesthesia. Design. Randomized double-blind controlled study. Settings. Karolinska University Hospital, Huddinge, Sweden. Population. 260 women scheduled for elective cesarean section were enrolled in the study. Methods. The treatment group (n= 130) received 40 mL bupivacaine (2.5 mg/mL) with adrenaline (5 μg/mL) (Marcain® adrenalin) and the control group (n= 130) received 40 mL saline solution (0.9%), which was, in both groups, injected close to the fascia before closure of the wound. Main outcome measures. Morphine consumption and mean resting pain intensity numerical rating scale at 12 and 24 hours were the primary outcome variables. Other assessments for pain as well as mobilization parameters were considered secondary. Results. Morphine requirements were significantly less in the bupivacaine group, 19.0 mg/woman, compared with 24.0 mg/woman in the placebo group, during the first 12 postoperative hours. During this time period there was also a trend towards a difference between groups in mean pain intensity, but significant only during the first six hours. Over the whole first postoperative 24 hours, there were no differences in either morphine requirement or pain intensity between groups. Conclusions. A single injection of bupivacaine with adrenaline in the surgical wound decreases the need for morphine requirements for the first 12 postoperative hours and contributes to safe and effective pain management in women undergoing cesarean section.

Get access to the full text of this article

Ancillary