Ropivacaine abdominal wound infiltration and peritoneal spraying at cesarean delivery for preemptive analgesia

Objective: To determine whether ropivacaine infiltration into all layers of the abdominal cesarean wound and spraying of the peritoneum decreases postoperative pain. Methods: A randomized controlled trial of women undergoing cesarean delivery under general anesthetic allocated to receive either 30 mL of 0.75% ropivacaine or 30 mL of saline into the wound, including spraying of the peritoneum. Postoperative pain and need for rescue opioids were assessed. Results: Of the 50 women in the ropivacaine group, 24 (48%) required pethidine or experienced severe pain within 1 hour postoperatively compared with 47 (94%) of 50 women in the control group (relative risk 0.51, 95% CI, 0.38-0.69). The amount of pethidine used in the first hour was reduced in the ropivacaine group (mean difference -58, 95% CI, -73.53 to -42.40). Use of diclofenac and tramadol/paracetamol was also reduced in the ropivacaine group. Conclusion: Ropivacaine wound infiltration and peritoneal spraying during cesarean delivery under general anesthetic reduces severe pain and need for opioids. (C) 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.