title: Effect of high-volume systematic local infiltration analgesia in Caesarean section: a randomised, placebo-controlled trial.
abstract: BACKGROUND
  Pain after Caesarean section is often treated with opioids with a risk of side effects. Wound infiltration with local anaesthetics is effective and has few side effects, but volume vs. dose concentration has not been examined.
  
  
  METHODS
  Ninety patients scheduled for elective Caesarean section included in a randomised, double-blinded, placebo-controlled trial receiving infiltration with 50 ml ropivacaine 0.5% or 125 ml ropivacaine 0.2% or 50 ml 0.9% saline (placebo) during surgery. Surgery was performed under lumbar spinal anaesthesia. Primary endpoint was post-operative pain. Secondary endpoints were rescue analgesic, post-operative nausea and vomiting, time spent in the postanesthesia care unit (PACU) and time to first mobilisation.
  
  
  RESULTS
  No difference in pain response between groups, but time until maximum pain score was prolonged in the ropivacaine 0.5% group compared with the placebo group (P = 0.0493). The administration of ketobemidone at 24 h post-operatively in the ropivacaine 0.5% group was reduced compared with the placebo group (P = 0.020), and between the ropivacaine 0.2% group and the ropivacaine 0.5% group (P = 0.044). No significant differences between groups were found concerning time spent in the PACU, to first mobilisation or in number of women with nausea/vomiting (P ≥ 0.05). No complications related to ropivacaine were observed.
  
  
  CONCLUSIONS
  Systematic infiltration with a high concentration, low volume compared with low concentration, high volume showed no significant effect on post-operative pain intensity. However, a statistically significant, but clinically limited opioid sparing effect was demonstrated compared with placebo in the high concentration, low volume group.
authors: Department of Anaesthesiology, Hvidovre University Hospital, Hvidovre, Denmark.
authors: K R
authors: KR
authors: Larsen
authors: B B
authors: BB
authors: Kristensen
authors: M A
authors: MA
authors: Rasmussen
authors: Y H
authors: YH
authors: Rasmussen
authors: T
authors: T
authors: Weber
authors: B
authors: B
authors: Kristensen
authors: H
authors: H
authors: Kehlet
mesh_terms: D000328:Adult; D000577:Amides; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local; D002585:Cesarean Section / Q000379:methods*; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D000077212:Ropivacaine; D017409:Sufentanil / Q000627:therapeutic use
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil