Postoperative Pain
Conditions
Brief summary
Analgesia following surgery associates different intra-venous or oral analgesic drugs and sometimes opioids. To reduce opioid consumption, loco-regional anaesthesia might be administered as a complement. In the specific context of caesarean sections, pain control is mandatory to enable the mother to take care of her offspring and shorten their hospital stay. This intervention is mainly performed under neuraxial anaesthesia (spinal or epidural), enabling the injection of morphine in the subdural or epidural space, as part of a multimodal analgesia regimen. Studies have evaluated continuous wound infiltration catheters (CIC) and ultrasound-guided (UGD) transabdominis plane (TAP) block, and both techniques and both techniques reduce postoperative morphine consumption. Recent studies have compared the two techniques and found conflicting results. Furthermore, they did not consider caesarean section performed under epidural analgesia, with a different neuraxial injection site, neither did they compared pain after postoperative day 2. Consequently, the aim of this study was to compare resting and standing pain up to postoperative day 3 after caesarean section performed under spinal or epidural anaesthesia and receiving either USG-TAP block or CIC. Baseline hypothesis was that the continuous infiltration provided a better analgesia at day 2.
Interventions
DRUGUSG-TAP block
DRUGCIC
Sponsors
University Hospital, Caen
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Informed consent, * Age\>/=18 years, * Caesarean section under spinal or epidural anaesthesia * Technique surgical Cohen Stark méthod.
Exclusion criteria
* Patient refusal, * Patient under guardianship, * Contraindication to one of the two techniques, * Cesarean section under general anesthesia * Allergies to local anesthetics * Maternal instability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative standing pain at day 2 | Evaluate standing pain at 48 hours postoperatively | Assessment of Pain on Mobilization by a Numeric Scale of Pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| standing and resting pain measured during the first 3 days | Evaluate pain at during 3 days postoperatively | Assessment of Pain by a Numeric Scale of Pain |
| Cumulative dose of Tramadol during the first 3 days | during the first 3 days | — |
| Cumulative dose of nefopam during the first 3 days | during the first 3 days | — |
| Cumulative dose of oxycodone during the first 3 days | during the first 3 days | — |
| patient comfort assessed daily by visual analogic scale | during the first 3 days | by visual analogic scale |
Outcome results
None listed