Is inferior dissection of the rectus sheath necessary during Pfannenstiel incision for lower segment Caesarean section? A randomised controlled trial

ObjectiveThe objective was to determine the benefit of non-dissection of the rectus sheath inferiorly in a Pfannenstiel incision during an elective Caesarean section with regard to operative blood loss and post-operative pain.DesignA randomised controlled trial.SettingThe Royal Free Teaching Hospital in London.PopulationOne hundred and twenty women who underwent elective Caesarean section delivery.MethodWomen were randomised to have dissection or non-dissection of the rectus sheath inferiorly during an elective Caesarean section.Main outcome measuresEstimated blood loss during the operation, as well as the difference between pre- and post-operative haemoglobin levels. Post-operative pain was assessed by the visual analogue scale, a verbal rating scale and the use of post-operative analgesia. Patient satisfaction was assessed by a verbal rating scale.ResultsThere was no significant difference in the estimated blood loss during the procedure between the two groups; however, the mean difference between the pre-operative and post-operative haemoglobin was significantly smaller in the study group (p = 0.05). There was a statistically significant difference in both the visual analogue scale (p-value = 0.03) and the verbal rating scale scores (p-value = 0.02) for pain between the two groups, with lower scores for the study group. There was no overall difference in the verbal rating scale scores for patient satisfaction.ConclusionNon-dissection of the rectus sheath inferiorly in Pfannenstiel incisions during Caesarean section procedures is associated with a significant reduction in the post-operative pain as well as a smaller drop in post-operative haemoglobin.