Effect of high-volume systematic local infiltration analgesia in Caesarean section: a randomised, placebo-controlled trial
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Effect of high-volume systematic local infiltration analgesia in Caesarean section : a randomised, placebo-controlled trial. / Larsen, Klaus Richter; Kristensen, B B; Rasmussen, M A; Rasmussen, Y H; Weber, T.; Kristensen, B; Kehlet, H.
I: Acta Anaesthesiologica Scandinavica, Bind 59, Nr. 5, 05.2015, s. 632-9.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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
N1 - © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
PY - 2015/5
Y1 - 2015/5
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
VL - 59
SP - 632
EP - 639
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 5
ER -
ID: 162693601