Wound infiltration with local anesthetics during cesarean delivery with intrathecal opioids: A systematic review and meta-analysis of randomized control trials.

Objective: To evaluate the effect on maternal pain of local anesthetic wound infiltration for intra-cesarean delivery analgesia in patients who also received intrathecal opioids. Data sources: Scopus, PubMed, and Cochrane Central Register of Controlled Trials were searched from the inception of each database to August 2023. Study eligibility criteria: All randomized controlled trials (RCTs) comparing the use of local anesthetic wound infiltration at the time of cesarean delivery versus no such infiltration in patients who also received intrathecal opioids. The primary outcome was pain scores at 24 h with movement. Secondary outcomes included pain scores at 12, 48, 72 h with movement and at rest, opioid consumption at 48 h, length of hospitalization, and side effects. Study appraisal and synthesis methods: Results were summarized as mean difference (MD) or risk ratio (RR) with associated 95% confidence intervals. Quality of studies was evaluated by Results: Eight RCTs ( Conclusion: Single-dose local anesthetic wound infiltration-of levobupivacaine, ropivacaine, or bupivacaine-administered subfascial at the time of cesarean delivery with intrathecal opioids is associated with reduced postoperative morphine consumption. The pain intensity scores at rest or with movement at 24 h postoperatively are decreased yet not significantly different, but significantly decreased at 48 h with movement and maternal side effects are comparable.