Analgesic efficacy and safety of absorbable gelatin sponge soaked with bupivacaine or bupivacaine and lidocaine in Cesarean section wounds.

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Background: Management of acute postoperative pain is one of the major challenges after CS. Administration of local anesthetic through wound instillation is an alternative to avoid opioids drawbacks. Aims To evaluate and compare the efficacy and safety of placement of subcutaneous gelatin sponge soaked with either bupivacaine 0.25% or a mixture of bupivacaine 0.25% and lidocaine 2% for postoperative analgesia after elective CS under general anesthesia.Materials and Methods: A total 105 parturient were equally allocated into either: Group C (control): received gel-foam soaked with 20 ml of 0.9% normal saline, Group B: received gel-foam soaked with 20 ml bupivacaine 0.25% or Group BL: received gel-foam soaked with a mixture of 10ml bupivacaine 0.25% and 10 ml lidocaine2%. Perioperative heamodynamics, visual analogue scale for pain (VASP), 1st analgesic request, total analgesic requirements, side effects and wound healing were recorded. Results: significantly lower heamodynamics, VASP at 1, 2, 8, 12& 24 hrs. and postoperative nausea and vomiting with lower total analgesics consumption were recorded in B&BL groups compared to C group. Analgesia was of earlier onset in BL group but more intense at 4hrs. in B group, otherwise the two groups were comparable. No wound healing complications were recorded in all groups. Conclusion: Gelatin-sponge soaked with bupivacaine or a mixture of lidocaine and bupivacaine in CS wounds was safe and effective in providing better heamodynamics and postoperative analgesia which was earlier in onset in mixture group but more profound in bupivacaine group with narrow clinical difference between the two groups .

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