Abstract
Author(s): Nada Alayed#, Salwa Neyazi#, Ahmed Sherif Abdel Hamid*, Haytham Hagsaad Abdelrahman Mohamed, Mohamed Abdel Razeq, Marawan Mohamed Gamal, Ahmed Reda, Gamal Mustafa Farag, Halima Al-Dhabyani, Mohamed Mahmoud Abdel Aziz, Ahmed Abdel Kader Ahmed, Asmaa Moatasem Elgharib, Mohammed Abdullah Alatawi, Amal Ali Fadlallah Kalifa, Mohamed el Sherbeeny
Introduction: Cesarean delivery is the most frequently performed surgical procedure globally. Administering analgesia through wound infiltration using narcotics or local anesthetics can lower pain levels and reduce the amount of postoperative analgesics needed. Objective: To assess the effects of tramadol infiltration at the incision site before skin closure in patients undergoing cesarean delivery on postoperative pain levels and the need for analgesics in comparison to lidocaine. Methods: This randomized controlled trial was performed at Ain Shams University Maternity Hospital, where 99 pregnant women scheduled for cesarean section delivery were RANDOMLY assigned to receive tramadol, lidocaine, or placebo subcutaneously before the closure of the skin. The primary outcome we measured was pain assessment at 2, 6, 12, and 24 hours post-operation using the visual analog scale (VAS). Secondary outcomes included the average time until the first analgesic request and the total diclofenac consumption within 24 hours. Results: VAS scores were statistically significantly lower in the Tramadol group when compared to the other two groups at 2 hours (h) (p< 0.001), 6 hours (p<0.001), and 12 hours (p<0.01). However, at 24 h, the VAS score in the Tramadol group was significantly lower than that in the Placebo group (p<0.01) but was similar to the Lidocaine group. The difference in VAS scores between the Lidocaine and Placebo groups was not statistically significant. The time to the first analgesic request was significantly prolonged in the Tramadol group: 2.5 ± 0.9 versus 2.4 ± 0.8 versus 5.8 ± 3.1 hours in the Placebo, Lidocaine, and Tramadol groups, respectively, p <0.001. Conclusion: Local wound infiltration with tramadol significantly reduced pain scores, delayed first analgesic request, and lowered 24-hour analgesic consumption. Lidocaine showed no additional benefit over placebo. Tramadol infiltration is effective for post-operative analgesia in cesarean sections.