Pain Associated With Cesarean Delivery Skin Closure: A Randomized Controlled Trial

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Patient Outcomes

Background:

• Cesarean delivery is a common surgical procedure.
• Skin closure methods, such as sutures and staples, are used to close surgical incisions.
• Understanding the impact of different closure methods on patient pain and medication use is crucial for optimizing postpartum recovery.

Purpose of the Study:

• To compare pain perception and pain medication use between women undergoing cesarean delivery with suture versus staple skin closure.
• To provide evidence-based recommendations for cesarean skin closure techniques.

Main Methods:

• Secondary analysis of a prospective, multicenter randomized clinical trial (2010-2012).
• Involved 746 women randomized to either suture (n=370) or staple (n=376) skin closure for low transverse cesarean incisions.
• Evaluated patient-reported pain scores and pain medication use during hospitalization and at 6 weeks postpartum.

Main Results:

• No significant differences in pain perception were found between suture and staple groups during hospitalization (median pain score 3.9 in both groups, P=.914) or 4-8 weeks postpartum (P=.949).
• Pain medication use was similar between groups, with no significant differences in intravenous morphine use during hospitalization (suture: 56 mg; staples: 54 mg, P=.545) or postpartum.

Conclusions:

• Suture and staple skin closure techniques for cesarean delivery result in comparable patient-reported pain and pain medication requirements.
• When considered with evidence of reduced wound morbidity with sutures, these findings support the use of suture closure for cesarean skin incisions.