Background and Goal of Study:
Postoperative pain in cesarean section is often a challenge for anesthesiologist, its inadequate control can prolong recovery and increase chronic pain. The aim of this prospective, observational, case-control study was to assess the analgesic efficacy of two different methods to pain control after cesarean section.
Materials and methods:
After approval of the local ethics committee, seventy women undergoing cesarean section were enrolled in the study, after the acquisition of written informed consent. Each patient underwent a spinal anesthesia (isobaric levobupivacaine 11 mg). Women were allocated by daily randomization into two groups, in GR-A (n= 37) patients were treated with i.v. elastomer (tramadol 400 mg, ketoprofen 400 mg, droperidol 2.5 mg and NS up to 100 ml, at 2 ml/h). In GR-B (n= 33) was placed a continuous wound infusion catheter (levobupivacaine 0.125%, 250 ml, at 5 ml/h).
Primary outcome: average pain intensity at rest in postoperative (PO) 24 and 48 hours evaluated by NRS (Numeric Scale Ratio). Secondary outcomes: request for rescue analgesics in the three PO days, the adverse events, the time for the first self mobilization and length of hospital stay (LOS). Statistical analyzes were performed using the t test or the Anova test for continuous variables, categorical variables were processed by the Chi2 test or Fischer ́s exact test. A p< 0.05 was considered statistically significance.
Results and discussion:
Demographic aspects of women were not different between the two groups. The mean value of NRS in the postoperative 24 hours was 3.33 +/-1.7DS in GR-A and 2.37 +/-0.75DS in the GR-B, p= 0.004. In the 48 hours mean NRS was in the GR-A 3.08 +/-1.47DS and in GR-B 2.41 +/-1.24DS, p= 0.046. The request for rescue analgesics is described in the graphic. There were no significant differences in the two groups about adverse effects, first self mobilization and LOS.
Conclusions:
Our experience has shown the superiority of continuous wound infusion in pain control after cesarean section. In the future may be of interest to assess the impact of this technique on the mother ́s ability to take care of their child.

Analgesia for cesarean section: comparison between continuous wound infusion and i.v. analgesics