THE COMPARISON OF INTRAINCISIONAL INJECTION OF LEVOBUPIV ACAINE VERSUS MELOXICAM ON POST CESAREAN SECTION PAIN RELIEF, RANDOMIZED CONTROLLED TRIAL
Radwa M.Z. Mohamed, Mohamed A. Elsenity, Waleed M. Khalaf , Ahmed Alanwar, Mohamed S. Ali, Shaimaa M.Mohamed
Department of Obstetrics and Gynecology – Ain Shams University
Objective: The study aims to evaluate the impact of local levobupivacaine and meloxicam incision site infiltration in women having cesarean sections, on postoperative pain and analgesic needs. Design: randomized controlled trial. Setting: Ain Shams Maternity university hospital. Patients and methods: a total of 156 pregnant women who are medically free and accomplished 37 weeks of gestational age (met the inclusion criteria) who underwent elective cesarean delivery at labor ward in the hospital. Intervention: The patients were divided into three groups: Group L (Levobupivacaine group) n=52 women: The wound (upper and lower flaps) was infiltrated with 20 ml of levobupivacaine hydrochloride 5 mg/ml. Group M (Meloxicam group) n=52 women: The wound (upper and lower flaps) was infiltrated with meloxicam 15 mg/3 ml diluted in 20 ml of 0.9%normal saline. Group P (Placebo group) n=52 women: The wound (upper and lower flaps) was infiltrated with 20 ml of 0.9% normal saline. Results: The VAS was significantly lowered in the levobupivacaine group compared to the other two groups at 2h, 4h, 12 h and 24 h. At 6h, The VAS was significantly lowered in the levobupivacaine group compared to the placebo group only with p value <0.001. On comparing the postoperative need of analgesics (rescue analgesia) in the three study groups. Time of need of first dose rescue analgesia was significantly longer in the Levobupivacaine group compared to the other two groups with p value <0.0001. Conclusion: levobupivacaine is a well-tolerated and effective local anesthetic that can be used to reduce pain scores and postoperative analgesic use if infiltrated in the surgical wound site in women after cesarean section deliveries.