Abstract
Background: Pain after caesarean section interferes with early ambulation, maternal comfort and the establishment of breastfeeding. Wound infiltration with local anaesthetic is a simple, inexpensive adjunct to multimodal analgesia, but the duration of relief from bupivacaine alone is limited. Clonidine is an established adjuvant for infiltration analgesia, whereas dexamethasone has been studied mainly in peripheral nerve blockade, with comparatively little evidence in wound infiltration. Objective: To compare clonidine and dexamethasone as adjuvants to 0.25% bupivacaine for wound infiltration in prolonging analgesia after elective caesarean section. Methods: In this prospective observational study, 60 women of ASA physical status I or II undergoing elective caesarean section under subarachnoid block were observed and grouped according to the wound infiltration adjuvant used, 30 women in each group. Group A received 20 ml of 0.25% bupivacaine with clonidine 3 µg/kg and Group Breceived 20 ml of 0.25% bupivacaine with dexamethasone 8 mg, infiltrated along the incision before skin closure. The primary outcome was duration of analgesia, defined as the interval from infiltration to first rescue analgesic request. Secondary outcomes were 24-hour tramadol consumption, pain intensity on a visual analogue scale, haemodynamic variables and adverse effects. Results: All 60 women completed the study. Duration of analgesia was longer in Group B than in Group A (467.5 ± 40.3 versus 364.1 ± 53.4 minutes), a mean difference of 103.4 minutes (95% CI 79.4 to 127.3; p < 0.001). Tramadol consumption over 24 hours was lower in Group B (74 ± 28 versus 128 ± 36 mg), a mean difference of −54 mg (95% CI −70.3 to −37.7; p < 0.001), a relative reduction of 42%. No adverse effects were recorded in either group. Conclusion: Dexamethasone 8 mg was associated with approximately 1.7 hours longer wound infiltration analgesia and a more than 40% lower 24-hour tramadol requirement than clonidine 3 µg/kg. No adverse effects were detected, although with 30 women per group the study could not exclude uncommon events. The findings derive from a single centre, group membership was not randomly assigned, and no bupivacaine-only comparison group was included; the differences reported are therefore unadjusted associations, and the additional benefit of either adjuvant over bupivacaine alone cannot be quantified from these data. Keywords: Wound infiltration; Bupivacaine; Clonidine; Dexamethasone;
Keywords: Wound infiltration; Bupivacaine; Clonidine; Dexamethasone; Caesarean section; Postoperative analgesia; Adjuvant.