The efficacy of abdominal binders in reducing postoperative pain and distress after cesarean delivery: a meta-analysis of randomized controlled trials

Objective: To evaluate the efficacy of abdominal binders in reducing postoperative pain, patient distress and surgical postoperative sequelae after cesarean delivery (CD). Methods: A comprehensive search in electronic databases (MEDLINE, EMBASE, and Cochrane Central) was performed up to February 2021. Selection criteria included randomized clinical trials investigating the application or not of abdominal binder after CD. The primary outcome was postoperative pain, measured using the visual analog scale (VAS) pain score. Secondary outcomes were divided into short- and long-term postoperative outcomes, including patient distress, need for additional pain medications, time to mobilization, return to normal daily activities, surgical site infection, fascial dehiscence or incisional hernia, and rectus abdominis diastasis. The summary measures were reported as mean difference with 95% confidence intervals (CI) using the random effects model of DerSimonian and Laird. An I2 (Higgins I2) value of greater than 0% was used to identify heterogeneity. Results: Four RCTs involving 601 women were included for meta-analysis: 310 (51.6%) were randomized to the abdominal binder and 291 (48.4%) to no abdominal binder group. There was no statistically significant difference between the two groups for VAS score either at 24 hours (MD - 0.97, 95% CI -2.23 to 0.30; p=0.13) and at 48 hours (MD -0.30, 95% CI -0.71 to 0.11; p=0.15). Conversely, there was a significant reduction in postoperative distress (SDS) both at 24 hours (MD -2.23, 95% CI -3.77 to -0.70; p=0.004) and 48 hours (MD -2.37, 95% CI -3.86 to -0.87; p=0.002). Conclusion: The present meta-analysis shows that the use of abdominal binders after CD significantly reduces patient distress.