• Thibaut Rackelboom, Solenn Le Strat, Stephane Silvera, Thomas Schmitz, Agnes Bassot, François Goffinet, Yves Ozier, Marc Beaussier, and Alexandre Mignon.
• Department of Anesthesiology and Intensive Care, Maternité Port-Royal, France.
• Obstet Gynecol. 2010 Oct 1;116(4):893-900.

ObjectiveTo evaluate in which anatomical layer (above the fascia or below the fascia) continuous wound infusion of local anesthetic, combined with nonsteroidal antiinflammatory drugs, through a multiorifice catheter has the best effectiveness during the first 48 hours on postoperative pain intensity after elective cesarean delivery.MethodsFifty-six women undergoing elective cesarean delivery under spinal anesthesia were randomly allocated to receive 48-hour continuous wound infusion either above the fascia or below the fascia using ropivacaine and ketoprofene through a multiholed wound catheter. No other systemic analgesics were used, except for rescue patient-controlled intravenous morphine. Evaluation by a blinded investigator included visual analog scale scores at rest and at movement, morphine consumption, patient satisfaction, residual pain at 1 and 6 months, and undesirable side effects.ResultsContinuous wound infusion below the fascia resulted in significantly reduced pain at rest and total postoperative morphine consumption (15.7 mg, 95% confidence interval 9.7-20.7 mg) compared with wound administration above the fascia (26.4 mg, 95% confidence interval 18.1-34.7). No undesirable side effects or residual pain requiring treatment were recorded in both groups, whereas analgesia and satisfaction were excellent.ConclusionAfter cesarean delivery, continuous wound infusion over 48 hours with ropivacaine and ketoprofene through a multiholed wound catheter inserted below the fascia results in better analgesia when compared with administration above the fascia.Clinical Trial RegistrationClinicalTrials.gov, www.clinicaltrials.gov, NCT01160913.Level Of EvidenceI.

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