Assessment of the Effect of Rectus Muscle Re-Approximation by Two Techniques Versus Non Re-Approximation During Caesarean Section on Postoperative Pain: A Randomized Controlled Trial

Abstract

Aim: To assess the effect of rectus muscle re-approximation by two different techniques during Cesarean Section on postoperative pain. Study Design: A prospective, single-blinded, randomized clinical trial. Patients and Methods: It included (n=156) primigravida who underwent Cesarean section. They were randomly allocated into three groups; Group (A): non-closure of rectus muscle, Group (B): re-approximation by three simple interrupted sutures, and Group (C) re-approximation by three vertical mattress sutures. Postoperative pain was assessed by visual analogue scale during hospital stay. Postoperative analgesia, amount of blood loss and occurrence of postoperative complications were also investigated. Results: Women with non-closure technique had significantly lower visual analogue score (VAS) at the end of 1 st 48 hours postoperative (2.86 ± 1.61) in comparison to other groups. Women who underwent re-approximation either with simple interrupted sutures or vertical mattress sutures had no difference as regard VAS (4.26 ± 2.19 vs. 4.80 ± 2.36; P value = 0.19). Regarding to postoperative analgesia intake, women with non-re-approximation had significant lower intake of analgesic drugs (170.76 ± 30.85 mg) in comparison to other two groups. Both techniques of muscle closure showed no difference in analgesic requirements postoperative. Conclusion: Rectus muscle approximation is associated with significant increase in postoperative pain and analgesia.