Key result
Wound site infiltration with ropivacaine, magnesium sulfate, and tramadol prolonged time to first rescue analgesia compared to ropivacaine and tramadol alone (5.97 vs 4.84 hours; P=0.001).
Why the study?
Postcesarean delivery pain affects maternal recovery, maternal-infant bonding, and breastfeeding, while advanced analgesic modalities may be limited in resource-constrained settings.
Does wound site infiltration with magnesium sulfate and tramadol adjunct to ropivacaine prolong the time to first rescue analgesia compared to tramadol adjunct alone in parturients undergoing cesarean delivery?
RCT
Triple-blind
randomly allocated
Does wound site infiltration with magnesium sulfate and tramadol adjunct to ropivacaine prolong the time to first rescue analgesia compared to tramadol adjunct alone in parturients undergoing cesarean delivery?
Absolute Event Rate: 5.97% vs 4.84%
p-value: p=0.001
The addition of magnesium sulfate to tramadol and ropivacaine for wound site infiltration significantly prolongs the time to first rescue analgesia after cesarean delivery.
Adding MgSO4 to tramadol in wound infiltration prolongs early post-cesarean analgesia; extends adjuvant evidence for local infiltration techniques.
Background: Postcesarean delivery pain is rated moderate-to severe which affects maternal recovery, maternal-infant bonding, and breastfeeding. In resource-limited locations, the availability and execution of advanced analgesic modalities are questionable. In our randomized double-blind study, we hypothesized that the duration of analgesia will be prolonged when a combination of both magnesium sulfate and tramadol are added as adjuvants compared to only tramadol as an adjuvant to local anesthetics for wound site infiltration (WSIF). Objectives: Our primary objective was to compare time for the requirement of first rescue analgesia. Secondary objectives were a comparison of postoperative analgesia evaluated by VAS score, total rescue analgesic dose in postoperative 24 h, and any adverse effects of the study drug. Methodology: Eligible parturients were randomly allocated to either Group A who received WSIF with ropivacaine and tramadol or Group B who received WSIF with ropivacaine, magnesium sulphate, and tramadol. Time for the requirement of rescue analgesic, total rescue analgesic dose, Visual Analog Score (VAS), and adverse events in the first 24 h were noted. Results: The time for requirement of the first rescue analgesic was longer in Group B (5.97 ± 2.226 h) compared to Group A (4.84 ± 1.859 h) P = 0.001. The total rescue analgesic dose in postoperative 24 h was (60.63 ± 20.58 mg) in Group A, whereas (59.03 ± 19.36 mg) in Group B, with P = 0.624. The VAS score was significantly less in Group B till 6 h postoperatively, after which VAS scores were comparable in both groups. Conclusion: The time for the first rescue analgesic requirement was significantly longer and VAS score was significantly less until 6 h postoperatively in WSIF with a combination of MgSO 2 and tramadol as adjuncts to ropivacaine compared to only tramadol adjunct to ropivacaine.
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Alagandala et al. (2025) conducted an RCT in Postcesarean delivery pain. Wound site infiltration with ropivacaine, magnesium sulfate, and tramadol vs. Wound site infiltration with ropivacaine and tramadol was evaluated on time for the requirement of first rescue analgesia (p=0.001). Wound site infiltration with ropivacaine, magnesium sulfate, and tramadol prolonged time to first rescue analgesia compared to ropivacaine and tramadol alone (5.97 vs 4.84 hours; P=0.001).
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