Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial

Ahmed Hussein; Haitham Torky; Rania Aly; Mazen Abdel-Rasheed; Ashraf El-Baz; Hossam Mahmoud; Sileem Sileem; Mahmoud Badawy; Zainab Sayd; Osama Dief; Ahmed Elsadek; Heba Marie; Ashraf Abo-Louz

doi:10.1515/jpm-2021-0624

Article

Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial

This article has been retracted. Retraction note.

Ahmed Hussein , Haitham Torky , Rania Aly , Mazen Abdel-Rasheed , Ashraf El-Baz , Hossam Mahmoud , Sileem Sileem , Mahmoud Badawy , Zainab Sayd , Osama Dief , Ahmed Elsadek , Heba Marie and Ashraf Abo-Louz

Published/Copyright: May 10, 2022

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From the journal Journal of Perinatal Medicine Volume 50 Issue 8

Abstract

Objectives

In low-income settings, postoperative pain relief could be challenging as a high patient/nurse ratio limits pain assessment and adequate analgesics administration. The multi-center prospective double-blinded parallel randomized controlled trial was done to compare lidocaine, tramadol, and placebo (saline) intraoperative wound infiltration to relieve post-cesarean section wound pain during the first 24 h.

Methods

Ninety-nine cases were equally randomized into three groups, each containing 33 pregnant women undergoing cesarean section under general anesthesia. During operation, the wound was infiltrated subcutaneously with 20 mL of 2% lidocaine solution in the first group, 2 mg/kg tramadol in the second group, and saline in the third group. The primary outcome was to assess the postoperative pain at 2, 4, 6, 12, and 24 h by the Yes-No-Don’t Know (YNDK) Scale, while the secondary outcome was to assess the need for further postoperative analgesia.

Results

Wound infiltration with lidocaine or tramadol was effective in pain relief, and both were superior to placebo. Wound infiltration with tramadol was superior to lidocaine in pain relief at 2 h and up to 24 h.

Conclusions

Wound infiltration with tramadol has a more prolonged pain relief effect than lidocaine in post-cesarean section pain relief in patients performing cesarean section under general anesthesia lasting up to 24 h, and both are superior to placebo in pain relief.

Keywords: cesarean section; lidocaine; pain relief; tramadol; wound infiltration

Corresponding author: Haitham Torky, Professor, Department of Obstetrics & Gynecology, October 6th University, Giza, Egypt, Phone: +20 1001230161, Fax: +20 225240066, E-mail: haithamtorky@yahoo.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The local Institutional Review Board approved the study.
Trial registration: The Pan-African Clinical trial registry PACTR201711002756172.

References

1. Souza, JP, Betran, AP, Dumont, A, De Mucio, Pickens, CMG, Deneux, C, et al.. A global reference for caesarean section rates (C‐model): a multicountry cross‐sectional study. BJOG 2015;123. https://doi.org/10.1111/1471-0528.13509.Search in Google Scholar PubMed PubMed Central

2. Carvalho, B, Cohen, SE, Lipman, SS, Fuller, A, Mathusamy, AD, Macario, A. Patient preferences for anesthesia outcomes associated with cesarean delivery. Anesth Analg 2005;101:1182–7. https://doi.org/10.1213/01.ane.0000167774.36833.99.Search in Google Scholar PubMed

3. De Brito Cançado, TO, Omais, M, Ashmawi, HA, Torres, MLA. Chronic pain after cesarean section. Influence of anesthetic/surgical technique and postoperative analgesia. Braz J Anesthesiol 2012;62:762–74. https://doi.org/10.1016/S0034-7094(12)70177-0.Search in Google Scholar PubMed

4. Maggioni, C, Margola, D, Filippi, F. PTSD, risk factors, and expectations among women having a baby: a two-wave longitudinal study. J Psychosom Obstet Gynecol 2006;27:81–90. https://doi.org/10.1080/01674820600712875.Search in Google Scholar PubMed

5. Kerai, S, Saxena, KN, Taneja, B. Post-caesarean analgesia: what is new? Indian J Anaesth 2017;61:200–14. https://doi.org/10.4103/ija.ija_313_16.Search in Google Scholar

6. McDonnell, NJ, Keating, ML, Muchatuta, NA, Pavy, TJ, Paech, MJ. Analgesia after caesarean delivery. Anaesth Intensive Care 2009;37:539–51. https://doi.org/10.1177/0310057x0903700418.Search in Google Scholar PubMed

7. Hegmann, KT, Weiss, MS, Bowden, K, Branco, F, DuBrueler, K, Els, C, et al.. ACOEM practice guidelines: opioids for treatment of acute, subacute, chronic, and postoperative pain. J Occup Environ Med 2014;56:e143–159. https://doi.org/10.1097/jom.0000000000000352.Search in Google Scholar

8. Bagi, IA, Ahmed, ME. Postoperative pain and analgesic prescription in Khartoum: evaluation of current practice. East Afr Med J 1993;70:502–5.Search in Google Scholar

9. Gupta, D, Drabik, A, Chakrabortty, S. A new nominal scale (yes-no-don’t know-YNDK scale) and its correlation with standard ordinal scale (numerical rating scale-NRS): our experience among university based pain clinic patients. WebmedCentral Pain 2016;7:WMC005226.Search in Google Scholar

10. Sahmeddini, MA, Azemati, S, Motlagh, EM. Local infiltration of tramadol versus bupivacaine for post cesarean section pain control: a double-blind randomized study. Iran J Med Sci 2017;42:235.Search in Google Scholar

11. Verstraete, S, Van de Velde, M. Post-cesarean section analgesia. Acta Anaesthesiol Belg 2012;63:147–67.Search in Google Scholar

12. Lavand’homme, P, Roelants, F, Waterloos, H, De Kock, MF. Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective cesarean delivery. Anesthesiology 2007;106:1220–5. https://doi.org/10.1097/01.anes.0000267606.17387.1d.Search in Google Scholar PubMed

13. Ghenaee, MM, Rahmani, S, Jafarabadi, M. Local lidocaine 2% in postoperative pain management in caesarean delivery. J Fam Reprod Health 2015;9:19–21.Search in Google Scholar

14. Sedek, AA, Kassab, FA. Study of the effectiveness of local anesthetic wound infiltration in post caesarean section pain relief. Al-Azhar Assiut Med J 2015;13:152–62.Search in Google Scholar

15. Jabalameli, M, Safavi, M, Honarmand, A, Saryazdi, H, Moradi, D, Kashefi, P. The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res 2012;1:53. https://doi.org/10.4103/2277-9175.100165.Search in Google Scholar PubMed PubMed Central

16. Sachidananda, R, Joshi, V, Shaikh, SI, Umesh, G, Mrudula, T, Marutheesh, M. Comparison of analgesic efficacy of wound infiltration with bupivacaine versus mixture of bupivacaine and tramadol for postoperative pain relief in caesarean section under spinal anaesthesia: a double-blind randomized trial. J Obstet Anaesth Crit Care 2017;7:85–9. https://doi.org/10.4103/joacc.joacc_20_17.Search in Google Scholar

17. Jayashree, V, Latha, K, Dhakshinamoorthy, M, Vinitha, V. Intraincisional injection of tramadol versus bupivacaine in post-caesarean pain relief. Int J Clin Obstet 2019;3:355–60. https://doi.org/10.33545/gynae.2019.v3.i5f.374.Search in Google Scholar

Received: 2021-11-21

Accepted: 2022-04-11

Published Online: 2022-05-10

Published in Print: 2022-10-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2021-0624

Keywords for this article

cesarean section; lidocaine; pain relief; tramadol; wound infiltration