Postoperative analgesia using bupivacaine wound infiltration with intravenous tramadol or dexamethasone following obstetric spinal anaesthesia.

Abstract

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. This study aimed to compare the analgesic effects of a combination of bupivacaine wound infiltration with either intravenous (IV) dexamethasone or tramadol after CS. This study was a randomized, double-blind, comparative study in a tertiary hospital. Clearance obtained from the Institution's Ethics and Research Committee. 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. 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. Combination of bupivacaine wound infiltration and IV tramadol provided better quality pain relief.