Obstetric Anesthesia

Anesthesia for Cesarean Delivery

Continuous Subcutaneous Instillation of Bupivacaine Compared to Saline Reduces Interleukin 10 and Increases Substance P in Surgical Wounds After Cesarean Delivery

Carvalho B, Clark DJ, Yeomans DC, et al (Stanford Univ School of Medicine, CA) Anesth Analg 111:1452-1459, 2010^§

Abstract

Background

Recent evidence suggests that locally delivered local anesthetics may exert tissue-damaging effects such as chondrolysis after intraarticular injection. Alteration of the inflammatory response is a potential mechanism for local anesthetic-induced tissue toxicity. In this study, we tested the effects of continuous local anesthetic infiltration on the release of inflammatory and nociceptive mediators in skin wounds after cesarean delivery.

Methods

Thirty-eight healthy women undergoing cesarean delivery with spinal anesthesia were enrolled in this study, and were randomized to receive subcutaneous surgical wound infiltration with bupivacaine 5 mg/mL or saline at 2 mL/h for 24 hours after cesarean delivery. Wound exudate was sampled at 1, 3, 5, 7, and 24 hours after cesarean delivery using a subcutaneous wound drain technique. Cytokines, chemokines, substance P, prostaglandin E₂, and nerve growth factor were assayed using multiplex Bio-Plex^® (Bio-Rad, Hercules, CA) and enzyme-linked immunosorbent assays.

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