الفهرس 
Pain
PATHOPYSIOLOGY AND PATHWAY OF PAINOnly 14 pages are availabe for public view
 |  | from | 192 |  |  |
| | | from | 192 | | |
Abstract
Delivery by caesarean section (CS) is becoming more
frequent and is one of the most common major operative
procedure performed worldwide. In the USA a CS rate of 26%
for all births is reported. The rate approaches 25% in Canada
and is over 20% in England, Wales and Northern Ireland (CDC,
2006 and RCOG, 2001).
Childbirth is an emotional experience for a woman and
her family. The mother needs to bond with the new baby as
early as possible and initiate early breastfeeding, which helps to
contract the uterus and accelerates the process of uterine
involution in the postpartum period (Novy, 1991).
So Achieving optimal pain relief after cesarean delivery
is an important issue due to a higher risk for thromboembolic
events, because of the surgery and the hypercoagulable state of
pregnancy and puerperium. In addition, these patients are
highly motivated and desire early ambulation in order to
breastfeed and care for their newborn (Roy Kessous et al.,
2011).
The degree of postoperative pain, as ultimately perceived
by the patient, is multifactorial and depends on variables such
as type and duration of the operation, type of anesthesia and
operation, type of anesthesia and analgesia used, and the patient‘s mental and emotional status (for example: laparotomy
for cesarean delivery versus laparotomy for uterine cancer (Pan
et al., 2006).
There are many methods of postoperative pain treatment.
The traditional and most widely used is parenteral opioids.
Parenteral narcotics in general are associated with nausea,
vomiting, constipation, respiratory depression, and sedation.
Newer technologies, such as continuous epidural analgesia or
patientcontrolled analgesia, have adverse effects, are expensive,
and require trained personnel and special equipment another
option for postcesarean pain management is to administer oral
analgesics immediately after the procedure (Faboyaa and
Unclesb, 2007; Cohen and Smetzer, 2005 and Jakobi et al.,
2000).
Preemptive analgesia is an analgesic regimen initiated
before the onset of tissue trauma and could have effects that
outlast the pharmacokinetic presence of the intervention and its
efficacy. It is based on the theory of prevention of central pain
sensitization. Different techniques of preemptive analgesia have
been reported, including intramuscular, intravenous,epidural ,
and local anesthetics used in peripheral nerve block,
intraperitoneal instillation, or wound Infiltration (Moiniche et
al., 2002 and Kaufman et al., 2005)
This study was conducted on women in Ain Shams
University Maternity Hospital.There was 480 patient allocated either to receive
preoperative subcutaneous lidocaine (n=240) or saline (n=240).
Our results show that no difference concerning
demographic data and no observed maternal or fetal adverse
effects.
Significant differences were noted between the groups
with regard to postoperative pain score in the first postoperative
2 hours(43.4+20 )for lidocaine group and (70+29)for control
group and p value= 0.004
No statistical difference in post operative pain score after
2 hours.
No significant difference between 2 groups concerning
analgesic requirement.