title: Bupivacaine-soaked absorbable gelatin sponges in caesarean section wounds: effect on postoperative pain, analgesic requirement and haemodynamic profile.
abstract: BACKGROUND
  Pain is a common distressing adverse effect in the early postoperative period following caesarean section. The aim of this study was to investigate the effect on postoperative pain, analgesic requirement and haemodynamic profile of placing a suprafacial bupivacaine-soaked absorbable gelatin sponge in the caesarean section wound.
  
  
  METHODS
  A total of 164 healthy patients scheduled to undergo general anaesthesia for elective caesarean section were randomised to a study group (n=81) or a control group (n=83). In the study group, a bupivacaine-soaked absorbable gelatin sponge was placed subcutaneously in the caesarean section wound. Intramuscular diclofenac 75 mg was given to all patients at 8-h intervals during the first 24h. Postoperatively, visual analogue scale pain scores, requirement for pethidine and diclofenac and changes in blood pressure and heart rate were compared between groups.
  
  
  RESULTS
  Pain scores were lower in the study group compared to the control group at all assessments (P<0.001). During the first eight hours after surgery, fewer patients in the study group required rescue pethidine compared with the control group (4 vs. 33, P<0.001). In the study group, total opioid and diclofenac consumption was lower (P<0.001), and blood pressure and heart rate were lower (P<0.001) compared to the control group.
  
  
  CONCLUSIONS
  Suprafascial wound placement of a bupivacaine-soaked absorbable gelatin sponge improved postoperative analgesia and decreased opioid consumption following caesarean section.
authors.affiliation: Department of Obstetrics and Gynecology, Izzet Baysal State Hospital, Bolu, Turkey; Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey. Electronic address: serapsimavli@yahoo.com.
authors.forename: S
authors.initials: S
authors.lastname: Simavli
authors.affiliation: Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey.
authors.forename: I
authors.initials: I
authors.lastname: Kaygusuz
authors.affiliation: Department of Obstetrics and Gynecology, Izzet Baysal State Hospital, Bolu, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Kinay
authors.affiliation: Department of Anesthesia and Reanimation, Izzet Baysal State Hospital, Bolu, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Akinci Baylan
authors.affiliation: Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Kafali
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000773:Anesthesia, Obstetrical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002585:Cesarean Section / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005780:Gelatin; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D005780:Gelatin; D002045:Bupivacaine
keywords: Bupivacaine; Caesarean section; Gelatin sponge; Postoperative pain