title: Improving continuous wound infusion effectiveness for postoperative analgesia after cesarean delivery: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate in which anatomical layer (above the fascia or below the fascia) continuous wound infusion of local anesthetic, combined with nonsteroidal antiinflammatory drugs, through a multiorifice catheter has the best effectiveness during the first 48 hours on postoperative pain intensity after elective cesarean delivery.
  
  
  METHODS
  Fifty-six women undergoing elective cesarean delivery under spinal anesthesia were randomly allocated to receive 48-hour continuous wound infusion either above the fascia or below the fascia using ropivacaine and ketoprofene through a multiholed wound catheter. No other systemic analgesics were used, except for rescue patient-controlled intravenous morphine. Evaluation by a blinded investigator included visual analog scale scores at rest and at movement, morphine consumption, patient satisfaction, residual pain at 1 and 6 months, and undesirable side effects.
  
  
  RESULTS
  Continuous wound infusion below the fascia resulted in significantly reduced pain at rest and total postoperative morphine consumption (15.7 mg, 95% confidence interval 9.7-20.7 mg) compared with wound administration above the fascia (26.4 mg, 95% confidence interval 18.1-34.7). No undesirable side effects or residual pain requiring treatment were recorded in both groups, whereas analgesia and satisfaction were excellent.
  
  
  CONCLUSIONS
  After cesarean delivery, continuous wound infusion over 48 hours with ropivacaine and ketoprofene through a multiholed wound catheter inserted below the fascia results in better analgesia when compared with administration above the fascia.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT01160913.
  
  
  METHODS
  I.
authors.affiliation: From Department of Anesthesiology and Intensive Care, Department of Radiology, Department of Obstetrics and Gynecology, Maternité Port-Royal, France; University Paris Descartes; Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Anesthesiology and Intensive Care, Saint-Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie Paris 6; Paris, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Rackelboom
authors.forename: Solenn Le
authors.initials: SL
authors.lastname: Strat
authors.forename: Stephane
authors.initials: S
authors.lastname: Silvera
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitz
authors.forename: Agnes
authors.initials: A
authors.lastname: Bassot
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.forename: Yves
authors.initials: Y
authors.lastname: Ozier
authors.forename: Marc
authors.initials: M
authors.lastname: Beaussier
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mignon
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002585:Cesarean Section; D005205:Fascia; D005260:Female; D006801:Humans; D007660:Ketoprofen / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000077212:Ropivacaine; D007660:Ketoprofen