Pain Associated With Cesarean Delivery Skin Closure: A Randomized Controlled Trial.
OBJECTIVE
To assess pain perception and pain medication use between women who underwent suture and those who underwent stapling for skin closure after cesarean delivery.


METHODS
This was a secondary analysis of a prospective, multicenter, randomized clinical trial conducted from 2010 to 2012 at three hospitals in the United States. We evaluated pain outcomes associated with skin closure of a low transverse skin incision for cesarean delivery. Patient-reported pain and pain medication use during hospitalization and 6 weeks postpartum were evaluated as prespecified secondary outcomes of the trial.


RESULTS
A total of 746 women were randomized to cesarean skin closure with sutures (n=370) or staples (n=376). There were no significant differences between the two groups with regard to pain perception during hospitalization (median average in-hospital pain score 3.9 in each group, P=.914), or at 4-8 weeks postsurgery (one in each group, P=.949). There were no significant differences in pain medication use during hospitalization (suture: 56 mg of intravenous morphine; staples: 54 mg, P=.545) or 4-8 weeks postpartum.


CONCLUSIONS
We observed no differences in patient-reported pain or pain medication use among women who underwent skin closure with suture and those who underwent stapling after cesarean delivery. Taken in conjunction with the primary analysis that showed decreased wound morbidity with suture closure, the results of this study support the use of suture closure of the cesarean delivery skin incision.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT01211600.


METHODS
I.
Department of Obstetrics and Gynecology, Geisinger Health System, Danville, Pennsylvania; the Department of Biostatistics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; New York University School of Medicine, New York, New York; and Yale School of Medicine, Obstetrics, Gynecology and Reproductive Sciences, New Haven, Connecticut.
A Dhanya
AD
Mackeen
Adeeb
A
Khalifeh
Jonah
J
Fleisher
Christina
C
Han
Benjamin
B
Leiby
Vincenzo
V
Berghella
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D011247:Pregnancy; D011446:Prospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*
D000700:Analgesics