الفهرس 
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Abstract
the most common major operative procedures performed
worldwide. Childbirth is an emotional experience for a woman
and her family. The mother needs to bond with the new baby as
early as possible and initiate early breastfeeding, which helps
to contract the uterus and accelerates the process of uterine
involution in the postpartum period. Any form of intervention
that leads to improvement in pain relief can positively impact
on early breastfeeding. Prompt and adequate postoperative pain
relief is therefore an important component of caesarean
delivery.
Pain causes increase in the sympathetic response of body
with subsequent rise in heart rate, cardiac work and oxygen
consumption. Prolong pain can reduce physical activity and
leads to venous stasis and an increase risk of deep vein
thrombosis and subsequent pulmonary embolism. In addition
there can be wide spread effects on gut and urinary tract
motility which may lead to post operative ileus, nausea,
vomiting and urinary retention. These problems are unpleasant
for the patients and may result in prolong hospital stay. Patients
show variable threshold for pain, however, 75% of surgical
patients have severe postoperative incisional pain. Pain relief
may cause good psychological and physical effects in patients,
Summary
95 9 5 which could lead to better recovery from surgical procedures
and early mobilization of patients to prevent complications like
deep vein thrombosis etc.
Postoperative pain after CS is usually managed with opioids. These agents generally exert their analgesic effects
through μ-receptors in the CNS, although there is evidence that
opioids may also act at peripheral opioid receptors.
Realistically, the analgesic efficacy of opioids is typically
limited by the development of tolerance or opioid related side
effects such as nausea, vomiting, sedation, or respiratory
depression. Local anesthetics cause reversible blockade of impulse
propagation along the nerve fibers by preventing the influx of
Na+ through the cell membrane of the fibers. Several studies
have reported on use of pre-emptive local anesthetics to relieve
postoperative pain, with results ranging from being beneficial
to conferring no benefit.
The local anesthetic may be administered by pre- or post
incisional abdominal nerve block “local anesthetic injected to
block the nerves before cutting the skin at the beginning of the
operation, or after closing the skin at the end” or pre- or postincisional
abdominal wound infiltration. It may also be administered by continuous wound irrigation.
Summary
96 9 6
Commonly used local anesthetic agents have sideeffects,
although these are very rare, ranging from allergy to
CVS and CNS effects. Local anesthetics eventually get
absorbed systemically and secreted in breast milk, but their
effects on breast fed babies have not yet been documented.
This is in sharp contrast to morphine or pethidine, both of
which have significant transfer to breast milk and may have a
sedative effect on the baby.
The objectives of this study was to assess the effect of
Xylocaine infiltration on the mother’s physical, social and
mental well-being, her ability to meet the physical,
psychological and nutritional needs of the baby, on pain relief
after CS and on opioids requirement. 150 parturient had
participated in this study, 75 parturient received saline
infiltration and the other75 received Xylocaine infiltration in
the wound and the rectus sheath space. The study had revealed
that local anesthetic infiltration is effective in decreasing the
intensity postoperative pain and the amount of the opioids
consumption