Lidocaine Patches After Cesarean Sections: A Randomized Control Trial

Abstract

ObjectivesLidocaine patches are a common topical analgesic therapy but have not been thoroughly investigated in the surgical or obstetric literature. We sought to investigate the impact of adding topical lidocaine patches to routine post-cesarean pain management on patients’ post-cesarean pain scores and opioid use. Study DesignThis is a prospective randomized subject blinded controlled trial of patients undergoing cesarean delivery at a single institution. Individuals were excluded if they had three or more cesarean sections, abdominoplasty, history of abdominal hernia repair with mesh, active polysubstance use, or history of opiate use disorder with current medication-assisted treatment. Patients were randomized via a 1:1 randomization scheme to a placebo patch or lidocaine patch. Baseline maternal characteristics were collected. The primary outcome was mean visual analog pain scores (0-10). Our secondary outcome was total morphine equivalents used over the post-operative hospital stay. Pre- and post-study surveys were performed to evaluate subject's prior analgesia use (including opioids) and patient experience in the study. ResultsA total of 100 patients were randomized and 93 had complete data for analysis (46 placebo group, 47 treatment group). Groups had similar baseline characteristics (age, BMI, ethnicity, surgical time, and estimated blood loss). Mean maximum post-operative pain score by visual analog scale did not differ between placebo or lidocaine patch groups on post-operative day 1 (p=0.3), day 2 (p=0.9), day 3 (p=0.07), or day 4 (p=0.09). Mean post-operative pain score by visual analog scale did not differ between placebo or lidocaine patch groups on post-operative day 1 (p=0.7), day 2 (p=0.6), day 3 (p=0.2), or day 4 (p=0.5). In the post-study survey, 0% of the respondents in the lidocaine patch group reported disruption of their care and 63% reported desired use of lidocaine patch in the future. ConclusionsThe addition of lidocaine patches did not significantly decrease the maximum or average post-operative pain scores via visual analog scale after cesarean sections. More research is needed into non-opioid pain management strategies in the post-operative period in obstetric care.