Double-blind randomized controlled trial comparing the effect of closure vs nonclosure of peritoneum during cesarean section on postoperative pain

Abstract

Background: Postoperative pain is one of the major discomforts interfering with baby-care after cesarean section. In our resource-poor hospital setup, we have addressed the issue of impact on postoperative pain, with peritoneal suturing keeping a standardized anesthetic and surgical technique; and postoperative conditions. Aim: To compare postoperative pain intensity after peritoneal closure vs nonclosure during cesarean section. Materials and methods: All total of 140 eligible subjects were allocated over one year into two equal groups as per the randomization list. In the control group, both visceral and parietal peritoneum was closed using absorbable suture; whereas in the study group, both peritoneal layers were left un-sutured. All patients received similar anesthetic and surgical techniques. Postoperative pain assessment was done at regular intervals by a 100 mm visual analog scale (VAS) at rest and on movement. Patient satisfaction was assessed by verbal rating scale (VRS). Per rectal diclofenac was given as an on-demand analgesic and recorded with dose. Both subjects and outcome assessors were blinded in the study. Results: Two groups were found to be matched with respect to basic characteristics, i.e., age, body mass index (BMI), gestational age, gravida, and surgical skill. Operative time was significantly (p < 0.00001) shorter in a nonclosure group. There was no significant difference found in the VAS score for postoperative pain (both at rest and on movement) observed at regular intervals (6/12/24/48 hours) between the two groups. Patient satisfaction level was also not significantly different, as demonstrated with a VRS score after 24 hours and 48 hours (p = 0.5776 and 0.2354, respectively). Postoperative on-demand analgesic dose was found significantly higher in closure group during the first 24 hours and later (p < 0.00001 and 0.00034, respectively). Conclusion: Peritoneum suturing can safely be avoided during the cesarean section. This would be significantly cost-effective with adequate patient satisfaction.