Pain, Referred Clinical Trial
Official title:
Efficacy of Subcutaneous Infiltration With Local Anesthetic During Elective Cesarean Delivery for Postoperative Pain Control: a Randomized Controlled Trial
The purpose of this study is to determine if giving an injection of numbing medication at the incision at the end of cesarean will help control pain AFTER cesarean delivery. This study seeks to assess pain relief with incisional infiltration of local anesthetic during cesareans performed under spinal anesthesia also using intrathecal opioids. Participants will receive the usual regimen of pain medication in spinal anesthesia. At the end of the cesarean delivery, while the participants are still under the spinal medication, participants will receive an injection, at the incision, either numbing medication (with or without epinephrine) or sterile saline. After the cesarean delivery, participants will receive, by mouth, commonly prescribed pain medications - these medications are oxycodone (an opioid/ narcotic), acetaminophen (or more commonly known as Tylenol), and ibuprofen.
The study assesses addition of subcutaneous bupivacaine with and without epinephrine to the
standard intrathecal morphine/fentanyl combination given during spinal anesthesia during
elective cesarean delivery on postoperative pain control as measured by postoperative usage
of oral opioids and a postoperative pain assessment scale. Comparing post-op pain scores and
oxycodone usage in patients who receive just intrathecal morphine to patients who receive
intrathecal morphine plus subcutaneous bupivacaine .25%, to patients who receive bupivacaine
.25% with epinephrine 1:200,000.
After cesarean delivery, all groups will actively control the use of post-operative pain
medication by indicating to the care nurse whether or not pain medication is desired. Pain
control for all groups will be the standard pain treatment: ibuprofen for mild to moderate
pain and percocet (oxycodone) for severe pain.
The U.S. Food and Drug Administration (FDA) has approved bupivicaine as an anesthetic and for
pain but the FDA has not approved bupivicaine to be given specifically for postoperative
cesarean pain. Acetaminophen, oxycodone and ibuprofen are being used as part of routine
clinical care for pain control after cesarean. Fentanyl and duramorph are being used in
spinal anesthesia and are FDA approved for regional anesthesia and used for this purpose in
routine clinical care.
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