Post-cesarean pain in closure versus non-closure of parietal peritoneum

Background: Management of pain after cesarean section not only brings comfort for patients but reduces the cost and duration of hospitalization. Objective: This study was performed to compare post-cesarean pain between two techniques of closure and non-closure of parietal peritoneum. Methods: This was a double blind clinical trial in which 160 pregnant women visited in Kosar hospital during the period from October 2003 to May 2004 were selected. All cases were operated under spinal anesthesia. A pfannenstiel incision of skin and lower segment of uterus was employed in all cases. The patients were randomly divided into two equal groups. In one group, parietal peritoneum was closed using a continuous chromic suture and in second group this layer was left unsutured. The analgesic requirement and the degree of pain over the first 24 hours following the surgery were further assessed. Two groups were compared by t-test and chi-square test. Findings: Two groups were similar in terms of age, weight, parity, and cause of cesarean. In non-closure group, the mean use of analgesic over 24 hours was 90.8 mg of Voltaren and 1.16 capsules of mefenamic acid whereas in closure group it was 112.9 mg of Voltaren and 2 capsules of mefenamic acid and the difference was found significant, statistically (p=0/000). The mean VAS in closure and non-closure groups over 24 hours was 5.5 and 4.24, respectively. The difference between two groups was also shown to be statistically significant (p=0/000). Conclusion: Non-closure of parietal peritoneum in cesarean section produces a significant reduction in post operative pain and analgesic use.