Lidocaine patches after cesarean sections: a randomized control trial

Christopher K Arkfeld; Anabel Starosta; Ecem Esencan; Zoe G Athens; Lisbet S Lundsberg; Audrey A Merriam

doi:10.1016/j.ajogmf.2024.101536

Lidocaine patches after cesarean sections: a randomized control trial

Am J Obstet Gynecol MFM. 2024 Nov 2;6(12):101536. doi: 10.1016/j.ajogmf.2024.101536. Online ahead of print.

Authors

Christopher K Arkfeld¹, Anabel Starosta², Ecem Esencan², Zoe G Athens², Lisbet S Lundsberg², Audrey A Merriam²

Affiliations

¹ Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT (Arkfeld, Starosta, Esencan, Athens, Lundsberg, Merriam). Electronic address: carkfeld@mgh.harvard.edu.
² Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT (Arkfeld, Starosta, Esencan, Athens, Lundsberg, Merriam).

PMID: 39491590
DOI: 10.1016/j.ajogmf.2024.101536

Abstract

Objectives: Lidocaine patches are a common topical analgesic therapy but have not been thoroughly investigated in the surgical or obstetric literature. We sought to investigate the impact of adding topical lidocaine patches to routine postcesarean pain management on patients' postcesarean pain scores and opioid use.

Study design: This is a prospective randomized subject-blinded controlled trial of patients undergoing cesarean delivery at a single institution. Individuals were excluded if they had three or more cesarean sections (CS), abdominoplasty, history of abdominal hernia repair with mesh, active polysubstance use, or history of opiate use disorder with current medication-assisted treatment. Patients were randomized via a 1:1 randomization scheme to a placebo patch or lidocaine patch. Baseline maternal characteristics were collected. The primary outcome was mean visual analog pain scores (0-10). Our secondary outcome was total morphine equivalents used over the postoperative hospital stay. Pre- and poststudy surveys were performed to evaluate subject's prior analgesia use (including opioids) and patient experience in the study.

Results: A total of 100 patients were randomized and 93 had complete data for analysis (46 placebo group, 47 treatment group). Groups had similar baseline characteristics (age, BMI, ethnicity, surgical time, and estimated blood loss). Mean maximum postoperative pain score by visual analog scale did not differ between placebo or lidocaine patch groups on postoperative day (POD) 1 (P=.3), day 2 (P=.9), day 3 (P=.07), or day 4 (P=.09). Mean postoperative pain score by visual analog scale did not differ between placebo or lidocaine patch groups on POD 1 (P=.7), day 2 (P=.6), day 3 (P=.2), or day 4 (P=.5). In the poststudy survey, 0% of the respondents in the lidocaine patch group reported disruption of their care and 63% reported desired use of lidocaine patch in the future.

Conclusion: The addition of lidocaine patches did not significantly decrease the maximum or average postoperative pain scores via visual analog scale after CS. More research is needed into nonopioid pain management strategies in the postoperative period in obstetric care.

Keywords: analgesia; cesarean section; lidocaine patches; postoperative pain.