Pain reduction through modification of the continuous Pfannenstiel suture
Postoperative pain can be reduced by creating a loop at the ends of the Pfannenstiel suture.
Here, too, chance played a role. I was assisting a junior doctor with a caesarean section. When tying the corner knot, she made an air knot, which she immediately wanted to undo. At that moment, it occurred to me that a corner knot does not have to be tied tightly at all in a continuous suture. It only has to hold the thread between the corner knots sufficiently securely. A tight knot only unnecessarily compresses the fascial tissue. If a pain receptor is also tied, it only causes unnecessary pain. As a result, I instructed my doctors to place the sutures loosely on the tissue when continuing the Pfannenstiel suture, but to ensure sufficient tension in between.
In the following period, we had the impression that we were observing less postoperative pain. Now we wanted to conduct a prospective study. I motivated the assistant doctor Rüdiger Schug to do his doctorate on this topic. Therefore, a pilot study was conducted first, in which a loop knot was placed in 9 female patients. 11 women who had been operated conventionally served as a comparison. It was found that mobilisation was faster and that pain levels were lower. The consumption of painkillers and the wound pressure measurement showed no differences. Essentially, the pilot study showed a reduction in pain by modifying the continuous Pfannenstiel suture.
The results were registered as a poster at the DGGG Congress 8/2018. The planned prospective randomised double-blind study has not yet been carried out at either the Women’s Clinic at the Fulda Clinic or at the University Women’s Clinic in Mainz.
I would be very grateful if someone could carry out this study so that, if possible, as many patients as possible would suffer less postoperative pain after a change in methodology. For new mothers, the puerperium and the mother-child bond would also be facilitated. LS