Influence of uterine exteriorization versus in situ repair on post-cesarean maternal pain: a randomized trial

Abstract

This study was done to compare post-cesarean delivery pain associated with routine exteriorization of the uterus versus in situ uterine repair in the puerperium. This prospective study included 206 women who underwent cesarean delivery under general anesthesia and who were randomly assigned to two groups based on the site of uterine repair: exteriorized uterine repair (102 women) versus in situ uterine repair (104 women). Exclusion criteria were neuraxial blockade and patient refusal to participate. Visceral and incisional pain was assessed on the first and second postoperative nights using a visual analog score of 0-100 mm. There were no significant differences between the groups in maternal age, weight, gestational age, race, preoperative hemoglobin or gravidity. All subjects underwent general anesthesia and had a low transverse incision of the uterus. Exteriorization was associated with higher postoperative visceral pain scores: first night 66.7 vs. 43.5 (P<0.001); second night 44.6 vs. 23.9 (P<0.001). The incidence of postoperative fever and wound infection, postoperative hemoglobin and duration of hospital stay were similar between groups. Exteriorization of the uterus for repair of the uterine incision increases the first- and second-night postoperative pain significantly in women undergoing cesarean section.