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Randomized Controlled Trial
. 2021 Jan 22;16(1):e0245645.
doi: 10.1371/journal.pone.0245645. eCollection 2021.

The extraperitoneal French AmbUlatory cesarean section technique leads to improved pain scores and a faster maternal autonomy compared with the intraperitoneal Misgav Ladach technique: A prospective randomized controlled trial

Kaouther Dimassi  1   2 , Ahmed Halouani  1   2 , Amine Kammoun  1 , Olivier Ami  3 , Benedicte Simon  4 , Luka Velemir  5 , Denis Fauck  6 , Amel Triki  1   2
Affiliations
Randomized Controlled Trial

The extraperitoneal French AmbUlatory cesarean section technique leads to improved pain scores and a faster maternal autonomy compared with the intraperitoneal Misgav Ladach technique: A prospective randomized controlled trial

Kaouther Dimassi et al. PLoS One. .

Abstract

Objective: To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions.

Study design: One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome.

Results: Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04-2.41] vs. 2.93 [2.46-3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups.

Conclusions: Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.

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Conflict of interest statement

The authors have read the journal's policy, and the authors of this study have the following competing interests to share: OA, BS, and DF work for Ramsay Health Care. However, none of the authors receive a salary for their work, nor did they receive any funding for this research. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Figures

Fig 1
Fig 1. CONSORT 2010 flow diagram.
Fig 2
Fig 2. General linear model analysis of PAMS score at selected time points post-CS.
Hypothesis tested was whether overall PAMS differed between FAUCS and MLCS (Technique variable), PAMS would decrease over time (Time variable), and the rates of decrease (interaction) would differ between FAUCS and MLCS. Data are shown as mean ± SEM. Dashed lines represent model predictions for fixed effects (technique, time, and technique × time). Effect of Technique χ2 (df) = 46,38 (1,94); p < 0.001; R2 0.192; raw p < 0.001. Effect of Time χ2 (df) = 70,57 (2,94); p < 0.001; R2 .144; raw p < 0.001. Effect of Technique x Time χ2 (df) = 13,46 (2,94); p = 0.011; R2 0.037; raw p = 0.001.
Fig 3
Fig 3. Cox proportional hazards model analysis of percentage of patients exhibiting autonomy at selected time points post-CS.
Hypothesis tested was that FAUCS would result in more rapid gain of the “autonomy” measure. Effect of Technique χ2 (df) = 625 (1); p < 0.001; R2 0.174; raw p < 0.001. Effect of frailty (patient) χ2 (df) = 490 (1); p < 0.001; R2 .758; raw p < 0.001.
See this image and copyright information in PMC

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