Abstract
Author(s): Amr Riad, Mohamed Taha, Sarah Hamada Mohamed Hamza* and Ahmed Mohamed Abdelhamed
Aim: To investigate the effect of intraperitoneal instillation of lidocaine on post-cesarean delivery pain.
Patients and Methods: This study is a Prospective, Randomized, Double blinded, Placebo-controlled Clinical trial, was carried out at Ain shams university hospital Obstetrics and Gynecology department, on (200) women divided into:2 groups: (Group I) (Lidocaine group): comprised 100 women who received 20ml of 2% lidocaine with epinephrine (1:200,000, (Group II) (Placebo group) which is the (COTROL GROUP): comprised 100 women who received 20ml normal saline, during the time period from 1st of August 2021to the end of Novamber 2021.
Results: The pain scores are significantly lower in the Lidocaine group at 4 hours (mean difference=14.8, 95% CI=13.0 to 16.6, P-value <0.0001), 6 hours (mean difference=17.6, 95% CI=15.7 to 19.5, P-value <0.0001), and 12 hours (mean difference=18.8, 95% CI=17.2 to 20.4, P-value <0.0001). Test of within-subjects effects shows a statistically significant effect of time (F=2303.090, df= 2, P value < 0.001) with a statistically significant Group * Time interaction (F=24.620, df= 2, P value < 0.001) Stabbing pain and tension-type pain were more common in the Control group (14% vs. 2%, p-value=0.002 and 8% vs. 0%, P-value=0.007, respectively). On the other hand, burning pain was more common in the Lidocaine group (26% vs. 7%, P-value < 0.001) Significantly fewer patients required supplemental analgesic in the Lidocaine group compared with the Control group (35% vs. 92%, respectively, P-value < 0.001). The consumption of paracetamol, diclofenac sodium and nalbuphine as well as the cumulative analgesic consumption are all significantly less in the Lidocaine group (all P-values < 0.001). Fewer patients in the Lidocaine group complained of nausea (23% vs. 48%, P-value < 0.001). The incidence of vomiting was comparable in both groups (P-value=0.171).
Conclusion: Intraperitoneal instillation of 20 ml of 2% lidocaine with epinephrine (1:200.000) decreased the post cesarean pain scores and the for opioids, is easy to use with high safety margin, does not require, and is cost effective.