Pain reducing Technique for rectus sheath closure in elective cesarean sections: randomized clinical trial

Objectives: The aim of this study is to compare the effects of alternative techniques for closingrectus sheath on maternal postoperative tension pain, early ambulation and breast feeding. Materials and Methods: randomized controlled clinical trial conducted upon cases attendingBenha medical school, Obstetrics and Gynecology department, Egypt .Sample size determined byDaniel formula equals six hundred patients.Patients undergoing elective Caesarean sections weredivided in two groups of three hundred patients in each group. Group one (classic closure group) in which the sheath closed continuously. In group two (the new technique) the rectus sheathclosure began in the midline by separate sutures to the left angle of the sheath. The right side ofthe sheath edge closed by separate sutures beginning at the midline and continued to the right angle then returned to the midline of the sheath and tied separately. The two groups of patients were observed for the durationof surgery, post-operative pain (evaluated by visual analogue scale of pain), early ambulation andearly breast feeding. Results: patients in group two (the new technique) had reported significant low postoperativepain on visual analogue scale of pain with P value equals 0.00001 in severe form of pain. Thezero score (no pain) was 10% in the new technique group versus 1.6% in the control groupwith P value equals 0.0001. Conclusion: Closing the rectus sheath in elective cesarean sections in two halves by separatestitches reduces pain scores and allows early ambulation and breast feeding in elective cesareansections.