الفهرس 
P OST C ESAREAN S ECTION P AINOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Objective: To assess the efficacy of burying knots beneath the rectus sheath as an alternative technique for its closure during elective cesarean section in reducing postoperative pain and discomfort. Which is considered primary outcome(evaluated by Visual analogue scale of pain), need for extra analgesia within the first 48 hours postoperative, Granuloma, Early ambulation and Early breast feeding being secondary outcomes in women planned for elective lower segment cesarean section.
Methods: This study was carried out at Ain Shams Maternity Hospital. 400 pregnant women planned for elective lower segment cesarean section were distributed into two equal groups. Control group 200 women. In this group, Rectus sheath closure done by simple running continuous sutures with the knots beneath the subcutaneous layer. and study group, In which Rectus Sheath closure done by Knot burial technique. Postoperative Pain was notified.
Results: This present study showed that there is no statistically significant difference between the two groups according to demographic data (age p = 0.374, BMI p = 0.225 and parity p = 0.134), early ambulation between the new technique group and control group (p = 0.112) and early breast-feeding first 2hrs post spinal effect (p = 0.126). Our results showed that there is highly statistically significant difference between two groups regarding pain scores in the 1st 24 hours postoperatively (mild, moderate and sever p = <0.001), statistically significant higher pain scores in control group compared to new technique group at 1st week (no pain, mild and moderate p = 0.019, 0.367, 0.009 respectively). There is statistically significant difference between two groups regarding pain scores at the 2nd week postoperatively (no pain, mild and moderate p = 0.029, 0.037, 0.012 respectively), According to secondary outcomes, there is statistically significant difference in favor of the new technique in comparison to the control group according to need for extra analgesia (p = <0.001) and statistically significant difference between the two groups regarding wound assessment (granuloma formation) (p = 0.014).in directional to Early ambulation, two hours post spinal, the difference was statistically insignificant (x2=2.525, p=0.112). According to early breast-feeding, two hours post spinal effect,the difference was statistically insignificant between both groups (x2=2.347, p=0.126).
Conclusion: In the present study, it is found that Knot burial technique is a very effective way of closing rectus sheath during elective cesarean section. Knot burial technique decreases post-operative pain scores especially in first and seventh postoperative days, it reduces the required administration of extra analgesia used within the first 48 hours postoperatively and allows early ambulation.