الفهرس 
Caesarean SectionOnly 14 pages are availabe for public view
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Abstract
Cesarean section delivery is becoming more frequent.
Childbirth is an emotion-filled event and the mother
needs to bond with her newborn baby as early as possible.
Any intervention that leads to improvement in pain relief is
worthy of investigation (Bamigboye, 2010).
The progressive increase in the incidence of caesarean
birth has been a notable feature of contemporary obstetric
practice and caesarean delivery is now the most frequent
major surgical procedure performed in obstetrics (Martin et
al., 2002).
According to the American Society of Anesthesiologist
practice guidelines for acute pain management in the
perioperative setting, acute pain is defined as pain present in a
surgical patient after a procedure. The WHO described pain
relief as a human right. Poorly managed post operative pain can
lead to complications and prolonged rehabilitation.
Uncontrolled acute pain is associated with the development of
chronic pain with reduction in quality of life. Appropriate pain
relief, reduces hospital costs, and increased patient satisfaction.
(Kehlet H etal.,2001) Sufficient control of post-caesarean section pain is
imperative to relieve patients‟ discomfort, as well as to
enhance early breast-feeding and infant care (Karlstr, 2007).
Preemptive analgesia refers to measures aimed at preventing
sensitization of cells within the spinal cord dorsal horn before
the onset of a noxious stimulus.. (Moiniche, S et al.,2000)
Epinephrine combined with lidocaine is the local
anesthetic combination gives a clinically optimal effect with
respect to anesthesia and homeostasis in all surgical
procedures. (Rozanski, 1988).
Several factors have contributed to inadequate
postoperative pain control, including a lack of understanding
of pain management strategies, mistaken beliefs and
expectations of patients, inconsistencies in pain assessment
practices and lack of analgesic regimens that account for
inter-individual differences and requirements. (Robert,
2010).
Providing effective post-operative analgesia is a key to
achieving early mobilization and good life style (Crosbie,
2012).
The objective of this study was to assess the efficacy
and safety of adding ef Epinephrine to lidocaine 2% in doserelated manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post-caesarean
section pain after general anesthesia.
After application of Inclusion criteria:
- Women undergoing C/S for various indications.
- Women refusing spinal anesthesia.
And Exclusion criteria:
- Women with known or suspected sensitivity to local
anesthesia or contraindicated for Epinephrin.
- Medical disorders that may be induced by pregnancy
as pre-eclampsia and gestational diabetes.
- Medical disorders aggravated by pregnancy as
cardiovascular disease, diabetes mellitus or renal disease.
- Women lacking adequate verbal communication.
- A Intraoperative comblication or morbid adhesionsthat
elongate oberative time.
total number of 200 women planned for elective
caesarean section was recruited, 2 groups were randomized
with a study group included 100 women received lidocaine
2% and epinephrine in dose-related manner and a control
group included 100 women received lidocaine 2% only.
The local anesthesia was injected in subcutaneous
layer of the skin in every patient according to the group.Post-caesarean section pain was assessed by visual
analogue scale after blinding.
The study had revealed that women who received
lidocaine and epinephrine were more satisfied and had
significant more time after caesarean section free of pain in
comparison to women who received lidocaine only by 120
minutes.
Women who received lidocaine and epinephrine
started breast feeding and mobilization earlier than women
who received lidocaine only.
Epinephrine prolonged the action of lidocaine as a
local anesthetic, this prolongation of action of local
anesthetic had a significant effect in early mobilization and
breast feeding and decrease in cost of analgesics.
In both groups, nobody developed post-operative
infection, Allergic reactions for General anesthesia. Only 3
patients in group A and 5 patients in group B developed Post
operative pyrexia,according to complications with local
anesthesia only 8 patients in group A and 9 patients in group
B developed redness and itchy sensation at insicional site .