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CC-BY 4.0 · Surg J (N Y) 2017; 03(03): e128-e133
DOI: 10.1055/s-0037-1604074
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rectus Muscle Reapproximation at Cesarean Delivery and Postoperative Pain: A Randomized Controlled Trial

Deirdre J. Lyell
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Mariam Naqvi
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Amy Wong
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Renata Urban
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Brendan Carvalho
2   Department of Anesthesia, Stanford University School of Medicine, Stanford, California
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Publikationsverlauf

22. November 2016

26. Mai 2017

Publikationsdatum:
11. August 2017 (online)

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Abstract

Objective Rectus muscle reapproximation at cesarean delivery (CD) is performed frequently by some obstetricians; however, the effect on postoperative pain is unclear. To this end, we investigated whether rectus muscle reapproximation increases postoperative pain.

Materials and Methods This is a prospective, double-blind, randomized controlled trial of women undergoing primary CD with singleton or twin pregnancy at >35 weeks' gestation. Women were randomized to rectus muscle reapproximation with three interrupted sutures or no reapproximation. Exclusion criteria were prior cesarean, prior laparotomy, vertical skin incision, active labor, chronic analgesia use, allergy to opioid or nonsteroidal anti-inflammatory drugs, and body mass index ≥ 40. Intra- and postoperative pain management was standardized within the study protocol. The primary outcome was a combined movement pain and opioid use score averaged over the 72-hour study period, called the Silverman integrated assessment. Movement pain scores were assessed at 24, 48, and 72 postoperative hours.

Results In total, 63 women were randomized, of whom 35 underwent rectus muscle reapproximation and 28 did not. Demographic and obstetric variables were similar between groups. Silverman integrated assessment scores during the 72-hour postoperative period were higher in the rectus muscle reapproximation group (15 ± 100% vs. –31 ± 78% difference from the mean; p = 0.04). Operative times were similar between groups (63 ± 15 vs. 65 ± 15 minutes; p = 0.61), and there were no surgical complications in either group. Maternal satisfaction with analgesia at 72 hours was high in both groups (85% [73–90] rectus muscle reapproximation vs. 90% [75–100]; p = 0.16).

Conclusion Rectus muscle reapproximation increased immediate postoperative pain without differences in operative time, surgical complications, or maternal satisfaction. Benefits of rectus muscle reapproximation should be weighed against increased postoperative pain, and analgesia should be planned accordingly.

Keywords

cesarean delivery - pain - rectus closure - rectus reapproximation