The cesarean section is one of the most commonly performed surgeries in the world and it
represents 20% of the births in France. Postoperative pain is moderate-to-severe during the
first 48 hours after this procedure. Thereby its control is prominent for the medical team in
order to shorten the duration of hospital stay as well as to permit an early return to daily
activities for these surgical patients.
Pain control after cesarean section is usually based on non-opioids and epidural
administration of morphine if an epidural catheter has been previously placed for the
procedure. However epidural morphine is associated with a number of side effects. Wound
infiltration with local anesthetics has been widely used in the multimodal management of
postoperative pain and it may reduce postoperative morphine consumption.
In patients enrolled for emergency cesarean delivery with epidural catheter, the objective of
this study will be to compare the analgesia provided by a local anesthetic wound 48-hours
infusion through a multiorifice catheter (ropivacaine 2 mg/mL) versus epidural analgesia
(epidural morphine bolus). Quality of pain control will be assessed with the measurements of
morphine consumption and pain scores at rest and during mobilisation over 48 hours. At 3
months, patients will be interviewed to assess their residual pain and their satisfaction.
It is hypothesized that local anesthetic wound infusion would be non-inferior than epidural
morphine analgesia to control pain after cesarean section, and be associated with a reduction
of side effects related to the analgesics.