Postoperative Analgesia using Bupivacaine Wound Infiltration with Intravenous Tramadol or Dexamethasone Following Obstetric Spinal Anaesthesia

Abstract

Context: Effective management of postcesarean section (CS) pain is important for the well‑being of mother and child; even in limited‑resource areas, there are drug options which can be explored to achieve this. Aim: This study aimed to compare the analgesic effects of a combination of bupivacaine wound infiltration with either intravenous (IV) dexamethasone or tramadol after CS. Setting and Design: This study was a randomized, double‑blind, comparative study in a tertiary hospital. Clearance obtained from the Institution’s Ethics and Research Committee. Methods: One hundred and twenty American Society of Anesthesiologists I or II pregnant women scheduled for CS under spinal anesthesia were recruited after giving consent. At the end of skin closure, all the patients received 20 ml of 0.1% plain bupivacaine for wound infiltration and IV dexamethasone 8 mg (Group BD) or tramadol 100 mg (Group BT). Outcome measures were time to first analgesic request, visual analog scale (VAS) scores, side effects, and patients’ satisfaction. Results: Time to first analgesic request was 3.2 ± 1.87 and 3.3 ± 2.01 h for BD and BT groups, respectively (P = 0.778). VAS scores for the first 2 h were lower in the bupivacaine/tramadol group compared to bupivacaine/dexamethasone group; the differences were statistically significant at 30 and 60 min (P = 0.027 and 0.008), respectively. Ninety percent versus 93% of the patients in BD and BT groups, respectively, expressed good to excellent satisfaction with pain relief. Conclusion: Combination of bupivacaine wound infiltration and IV tramadol provided better quality pain relief.

Keywords: Bupivacaine wound infiltration, cesarean section, intravenous dexamethasone, intravenous tramadol, postoperative pain