Lidocaine Patches After Cesarean Section
Condition: Postoperative Pain; Obstetric Pain; Opioid Use
MeSH terms: Labor Pain
Study type: Interventional
Phase: Phase 3

Summary: 
      The aim of this study is to investigate the impact of using lidocaine patches after cesarean
      section on pain control and opioid use in the immediate post-operative period. The hypothesis
      is the use of lidocaine patches in the immediate post-operative period will lead to a
      decrease in the use of opioids as pain control compared to patients that do not have a
      lidocaine patch in place. Additionally, the a decrease in the visual analog pain score
      compared to women who do not use a lidocaine patch in the immediate post-operative period
      following cesarean delivery is anticipated.
    

Detailed description: 
      The use of lidocaine as a local anesthetic is a common and widely used in practice. Lidocaine
      patches can be used for localized pain control and can be placed every 24 hours. The use of
      lidocaine patches in post-operative patients has been reported in one case report in
      obstetric literature. There is one study that reports decreased immediate postoperative pain
      when lidocaine patches were placed at laparoscopic port sites following gynecologic surgery
      as measured by visual analog scale score and the Prince Henry and 5-point verbal rating pain
      scale. There have been no studies looking at the impact of lidocaine patches in obstetric
      surgical procedures, specifically cesarean sections.

      Cesarean sections are one of the most common surgeries in the United States. Following
      cesarean sections it is common to utilize opioids in the hospital and upon discharge to
      manage patient's post-operative pain. According to the CDC overdose deaths involving
      prescription opioids were five times higher in 2017 than in 1999 with over 200,000 deaths.
      This creates an opportunity to decrease the use of post-operative opioids with the
      application of a lidocaine patch as an adjunctive post-operative pain management modality
      following cesarean sections.

      Lidocaine patches are a common topical analgesia therapy used for localized pain control in
      the inpatient and outpatient setting. It's use in the postoperative period is less understood
      and the use of topical lidocaine patches has not been thoroughly investigated in the surgical
      literature. Thus far, it has been shown as an effective therapy at laparoscopic port sites
      following laparoscopic appendectomies. It's use in obstetrical surgeries has not been
      studied. Overall, the limited research on this topic making it a valuable area of research.

      This study will involve prospective enrollment of women undergoing cesarean deliveries. Women
      will be randomized to receive a lidocaine patch or no lidocaine patch to be worn for 72 hours
      after delivery to help manage postoperative pain. This will be an adjunctive therapy in
      addition to the parental and oral narcotic pain medication that is routine prescribed. The
      utility of lidocaine patches for management of post-cesarean delivery pain will be assess by
      2 measures. The first measure will involve the total daily dose of narcotic used in morphine
      equivalent doses. The second outcome assessed will be subjective pain as measured on a 1-10
      scale and reported by the patients to nursing staff. This score will be averaged for each 24
      hour period post-operatively.
    

Intervention name(s): Lidocaine patch
Intervention type(s): Drug
Intervention description(s): Lidocaine patch to be placed in post-operative recovery area and used in addition to routine post-cesarean delivery pain management
Intervention MeSH terms: Lidocaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This will be a prospective randomized non-blinded controlled trial. All cesarean sections for women undergoing their first or second cesarean delivery will be included. Patients will be approached and consented during the pre-operative period when presenting for scheduled surgery or at the time of consent for a non-scheduled cesarean section. The lidocaine patch would be placed on the superior-lateral aspect of the Pfannenstiel incision in the PACU prior to being transferred to the postpartum floor.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment