Effectiveness of bilateral illioinguinal illiohypogastric nerve block and wound site infiltration as a part of post-operative analgesia in patients undergoing elective caesarean section under spinal anesthesia. A prospective cohort study

Introduction: Cesarean section is one of the most commonly performed surgical procedures. Postoperative pain after cesarean section is moderate to severe, though it has been neglected due to several reasons. Systemic opoids, local wound infiltration, and abdominal nerve blocks are among popular techniques used for postoperative pain after cesarean section in an area where epidural analgesia is barely practiced. Thus, this study aimed to assess the analgesic effectiveness of II-IH nerve block and wound site infiltration for pain management after cesarean section. Method: An institutional based prospective cohort study was conducted on 72 parturient scheduled for elective cesarean section. The parturients grouped based on whether they took II-IH, WSI or non-exposed groups. Data collection methods include preoperative chart review, intraoperative observation and postoperative patient interview starting from recovery room for 24 h. Time to first analgesic request, NRS score and total analgesic consumption were used as outcome variables. Continuous data were analyzed using one-way analysis of variance (ANOVA) or kuruska-walih H rank test depending on normality whereas categorical data analyzed by Pearson chi-square test. Result: Time to first analgesic request was significantly prolonged in II-IH groups compared to WSI and Non-exposed groups with p-value 0.01. Similarly, NRS score within 24 h was significantly lower in II-IH groups compared to Non-exposed Group at all follow up periods except at 2 and 24 h. However, WSI reduced NRS score, in a comparison with non-exposed group, only at 4 and 6 h with p-value of 0.04 and 0.02 respectively. In addition, the post hoc comparison of total tramadol consumption revealed significant difference between all the possible three comparisons. Conclusion and Recommendation: Although II-IH nerve block provides better and prolonged pain relief, WSI was also effective analgesic technique for post cesarean section pain. Therefore, we recommend use of either II-IH or WSI as a part of post-operative pain management for cesarean section. Further Randomized controlled trial studies were also recommended on similar area.