Does Intraperitoneal Instillation of Lidocaine at Cesarean Delivery Improve Postoperative Analgesia?
Condition: Pain
Study type: Interventional

Summary: 
      The instillation of local anesthetic into the peritoneum has been found to be safe and
      effective in reducing postoperative pain and morphine consumption after abdominal surgery. A
      review of studies reporting serum levels of local anesthetic after intraperitoneal delivery
      found no cases of clinical toxicity in any of the trials. The studies in this meta-analysis
      did not include post-cesarean delivery pain and there is a lack of data to support the use of
      intraperitoneal local anesthetic after cesarean section.

      The purpose of this study is to assess the efficacy of intraperitoneal lidocaine on
      postoperative pain scores after cesarean delivery. This study will compare a 20ml solution of
      lidocaine (400mg) with epinephrine 5mcg/ml versus normal saline (placebo) instilled into the
      peritoneum at the end of surgery in women undergoing cesarean delivery. The investigators
      hypothesize that intraperitoneal lidocaine will result in lower pain scores, reduce opioid
      consumption and opioid related side effects, and higher maternal satisfaction after cesarean
      delivery.
    

Detailed description: 
      Postoperative pain after cesarean delivery can have a significant negative impact on the
      mother's ability to care for her newborn and lead to complications such as thromboembolism,
      chronic pain, and depression. Postoperative analgesia for cesarean delivery has undergone
      remarkable improvement and is currently based on a multimodal approach to improve pain
      control and reduce the systemic complications of opiates. Despite this some patients still
      experience moderate to severe pain after cesarean delivery, and further strategies to improve
      analgesia and postoperative recovery are warranted.

      The use of intraperitoneal local anesthetics to reduce postoperative pain has been studied in
      a variety of surgical settings, such as hysterectomy, laparoscopic cholecystectomy and minor
      laparoscopic gynecological procedures. These studies have compared different local
      anesthetics and the timing of local anesthetic delivery in relation to surgery, for example
      pre-procedure, at the end of surgery or via continuous catheter infusion. Intraperitoneal
      lidocaine at the end of surgery was associated with lower postoperative pain scores after
      total abdominal hysterectomy (200mg lidocaine) and laparoscopic cholecystectomy (400mg
      lidocaine). There is a large growing body of evidence to support the use of intraperitoneal
      local anesthetic to reduce postoperative pain. However, there is a lack of data to support
      its use in postcesarean delivery pain. The investigators found one study reporting a
      decreased incidence of postoperative pain following intraperitoneal lidocaine instillation at
      the end of cesarean delivery, in which the parietal peritoneum had been sutured.

      The purpose of this study is to evaluate the efficacy of intraperitoneal lidocaine 400mg
      instillation at the end of cesarean delivery on maternal pain scores and satisfaction, in the
      context of a multimodal analgesic regimen inclusive of intrathecal opioids and systemic
      NSAIDs, acetaminophen and opioids. The investigators hypothesize that intraperitoneal
      lidocaine will decrease VAS pain scores, reduce opioid consumption and opioid related side
      effects, and increase maternal satisfaction after cesarean delivery.
    

Intervention name(s): Lidocaine; Placebo
Intervention type(s): Drug; Drug
Intervention description(s): Lidocaine 2% with epinephrine 5mcg/ml; 0.9% Sodium Chloride Solution
Other intervention name(s): Lidocaine HCl; Normal saline
Intervention MeSH terms: Lidocaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cesarean section; Lidocaine