Efectiveness of Bilateral Illioinguinal Illio Hypogastric Nerve Block and Wound Site Local Anesthetic Infiltration as a Part of Post Operative Analgesia in Patients Undergoing Elective Ceaserian Section Under Spinal Anesthesia at Debere Birhan Referral Hospital, Debere Birhan Ethiopia,2019:a Prospective Cohort.
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Date
2019-05
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Addis Ababa University
Abstract
Introduction - Cesarean section is one of the most commonly performed surgical procedures. Even though the postoperative pain after cesarean section is moderate to severe it has been neglected due to several reasons. Untreated pain has its own negative outcomes. Lately post cesarean section pain has been treated with opoids, local wound infiltration, and abdominal nerve blocks.
Objective-This study aims to assess the analgesic effectiveness of II-IH nerve block and local wound infiltration for post cesarean section pain management along with a non- exposed groups.
Method- An institutional based prospective cohort study was conducted in DBRH, in 2019 on patients who underwent elective cesarean section under spinal anesthesia and fulfill inclusion criteria of the study. Study participants were selected by systematic random sampling technique. Data collection methods include preoperative chart review, intraoperative observation and postoperative patient interview starting from recovery room for 24 hours. Time to first analgesic request, NRS score and total analgesic consumption was used as outcome variables. Socio demographic variables and others like parity, history of previous caesarian delivery was analyzed by ANOVA and chi square test. In addition, Kruskal wallis H test with post hoc analysis was used to compare pain score, total analgesic consumption and first analgesic request time. Categorical variables were analyzed by chi square.
Result- First analgesic request is significantly different between II IH and LWI, II IH and Non-exposed, and LWI and Non-exposed groups with p< 0.001. Similarly, NRS score within 24 hours is significantly different between all the three groups at all times measured with p≤ 0.05 except at 2nd and 24th hour. In addition, the post hoc comparison of total tramadol consumption is significantly different between all the possible three comparisons with p< 0.001 but total diclofenac consumption is significantly different only between II IH and Non-exposed group with p= 0.003.
Conclusion and Recommendation- Though II IH nerve block provide better and prolonged pain relief, LWI is also effective analgesic technique for post CD pain. Based on this we recommend use of II IH and LWI as a part of post c/s pain management.
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Keywords
Caesarian section, Illioinguinal illiohypogastric nerve block, Local wound infiltration