title: Incisional and epidural analgesia after caesarean delivery: a prospective, placebo-controlled, randomised clinical study.
abstract: BACKGROUND
  This study evaluated efficacy, safety and patient satisfaction with incisional analgesia with a subfascial catheter compared to epidural analgesia for pain relief following caesarean section.
  
  
  METHODS
  Forty patients were randomised after elective caesarean section to receive either intermittent 10-mL boluses of 0.125% levobupivacaine into the epidural space and physiologic saline into the surgical wound or intermittent 10-mL boluses of 0.25% levobupivacaine into the wound and epidural saline with a repeated 10-dose regimen. Analgesic efficacy was evaluated by numerical pain scores (0-10, 0=no pain, 10=worst pain) and based on the consumption of supplemental opioid. Side effects, patient satisfaction and plasma concentrations of levobupivacaine were recorded.
  
  
  RESULTS
  In the epidural group average pain scores were lower (1.8 vs. 3, P=0.006) and the consumption of local anaesthetic (29 mL vs. 38 mL, P=0.01) was smaller during the first four postoperative hours, after which both groups had pain scores of 3 or less at rest. All parturients were able to walk after the 24-h study period. The total consumption of rescue opioid oxycodone (32 vs. 37 mg, P=0.6) during the whole 72-h study period was low in both study groups. Side effects were mild and rare. Satisfaction scores were equally high in the two groups. Peak plasma concentrations of levobupivacaine were below the toxic range.
  
  
  CONCLUSIONS
  Incisional local analgesia via a subfascial catheter provided satisfactory pain relief with patient satisfaction comparable to that seen with epidural analgesia. This technique may be a good alternative to the more invasive epidural technique following caesarean section as a component of multimodal pain management.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Oulu University, Finland. pirjo.ranta@ppshp.fi
authors.forename: P O
authors.initials: PO
authors.lastname: Ranta
authors.forename: T I
authors.initials: TI
authors.lastname: Ala-Kokko
authors.forename: J E
authors.initials: JE
authors.lastname: Kukkonen
authors.forename: P P
authors.initials: PP
authors.lastname: Ohtonen
authors.forename: T H
authors.initials: TH
authors.lastname: Raudaskoski
authors.forename: P K
authors.initials: PK
authors.lastname: Reponen
authors.forename: N
authors.initials: N
authors.lastname: Rawal
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D002585:Cesarean Section; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine