تأثیر تزریق داخل نسجی بوپیواکائین در کاهش درد ، تهوع و استفراغ بعد از عمل سزارین در بیماران تحت بی حسی نخاعی

Introduction & Objective:  There are several studies showing the intra tissue anesthetic infiltration is effective to relief the post operative pain, whereas this effect is not observed in some other studies. The aim of this study was to evaluate the effect of intra tissue Bupivacaine infiltration in peritoneum, fascia and subcutaneous tissues on severity of pain, analgesic consumption, nausa and vomiting after cesarean section. Materials & Methods: In this double blind clinical trial, fifty candidates of cesarean under spinal anaesthesia were divided randomly into placebo (n=25) and intervention (n=25) groups. 20 ml of 0.25% bupivacaine and 20 ml of 0.9% saline was injected into parietal and visceral peritoneum, fascia and subcutaneous tissues in intervention and placebo subjects respectively. Severity of pain was measured according to visual analoge scale (VAS). Analgesic need was recorded during recovery and 2, 4, 8, 16 and 24 hours after surgery. Nausa and vomiting was also recorded during, immediately- and 24 hours after surgery and overall satisfactory of subjects in two studied groups were compared. Results: Mean of pain score exactly in 4 hour after surgery was significantly less in bupivacaine group (P=0.042). 24% of patients in intervention group and 12% of subjects in placebo group did not need analgesics. 20% of intervention patients and 52% of placebo subjects requested analgesic twice in 24 hours (P=0.07). Mean of analgesic consumption in 24 hours was significantly more in placebo group (P=0.048). Vomiting was similar in two groups. 76% of bupivacaine group and 60% of placebo group were overall satisfied (without statistically significance) Conclusion: Intra tissue bupivacaine infiltration during cesarean section reduces analgesic consumption in 24 hours after surgery and nausa episodes. Pain in peak of drug efficacy (4 hours after usage ) was reduced significantly.