Lidocaine-prilocaine cream versus local infiltration anesthesia in pain relief during repair of perineal trauma after vaginal delivery: a systematic review and meta-analysis

Abbas, Ahmed M.; Mohamed, Ahmed A.; Mattar, Omar Mohamed; Shamy, Tarek El; James, Cathryn; Namous, Lubaba O; Yosef, Ali; Khamis, Y.; Samy, Ahmed

doi:10.1080/14767058.2018.1512576

Cited by 10 publications

(4 citation statements)

References 25 publications

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“…Internationally the anesthetical methods used for repair of perineal lacerations grade II differs, international guidelines from up-to date recommend anesthesia with nerve block or local field block if no pre-existing anesthesia such as epidural anesthesia have been used during childbirth 49 . Studies have shown that topical local anesthesia with lidocaine cream have the same, or even better effect on pain relief than local infiltrative anesthesia 50,51 . Nitrous oxide has been shown be as effective and satisfying as local anesthesia during postpartum perineal repair 52 .…”

Section: Considerations When Repairing An Obstetric Perineal Lacerationmentioning

confidence: 99%

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

Hjertberg

2024

Linköping University Medical Dissertations

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ObjectivesThis thesis aimed to assess the impact of maternal body mass index (BMI) on pelvic floor during labor and focusing on pelvic floor function following an anal sphincter injury (OASI). Additionally, the objective was to design a study protocol for a randomized controlled trial (RCT) with the objective to evaluate the impact of supplementary anesthesia during the examination and repair of obstetric perineal lacerations. Material and MethodsStudy I was an observational prospective cohort study, conducted at the maternity ward Linköping University Hospital, including 207 primiparous women in the active phase of labor. Transperineal ultrasound was used for measurement of the anovaginal distance (AVD) during active phase of labor. AVD were analyzed in relation to the women´s BMI groups. Study II and III were nationwide Swedish register studies, including 6595 women with a first time vaginal birth complicated by an OASI. Data was sourced from the Swedish Perineal Laceration Register (PLR), based on medical records and patient reported outcome measurements (PROM). Women were categorized by BMI, and analyses were performed on PROM data at the 8 week follow-up (Study II), and at the 12 month follow-up (Study III), after an OASI. Study IV, is a study protocol for a RCT, with parallel groups. Women who undergo examination and repair of obstetric perineal lacerations (grade I and II) are randomized into two arms (1:1); analgesia with pudendal nerve block (PNB) with Ropivacaine®-the PNB group or analgesia with PNB in combination with patient-controlled sedation (PCS) with propofol, the PCS group. ResultsObese women exhibited a higher AVD compared to normal weight women. The mean AVD was 25 mm for primiparous women in the active phase of labor. Overweight and obese women reported fewer wound complications than normal weight women at 8 weeks postpartum. Additionally, overweight and obese women had a lower risk of anal incontinence (AI) at 8 weeks after an OASI compared to normal weight counterparts. However, at 12 months after an OASI, the risk of AI was comparable across BMI groups. Urinary incontinence (UI) was more prevalent among overweight and obese women, with a higher risk of UI both at 8 weeks and 12 months after an OASI compared to normal weight women. Overweight and obese women had a lower risk of reporting dyspareunia at 12 months after an OASI compared to normal weight women. Results from the ongoing RCT are pending. ConclusionsDifferences in the AVD during active phase of labor were observed between women with normal weight and those who were overweight or obese. The higher AVD in obese women compared to normal weight women may indicate a valuable anatomical distinction that could be protective for pelvic floor muscles vulnerable during labor. Furthermore, women sustaining an OASI after their first vaginal birth reported distinct complications at 8 weeks and 12 months postpartum based on BMI. Various explanations may underlie these differences in reported complications, including the hypothesis that women w...

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Section: Considerations When Repairing An Obstetric Perineal Lacerationmentioning

confidence: 99%

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

Hjertberg

2024

Linköping University Medical Dissertations

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“…These preparations are commonly used to treat patients with acute pain. Topical EMLA cream alleviates the pain of facial and perineal lacerations [12,13]. The cream is also effective as an analgesic for wound-related pain associated with chronic leg ulcers [14].…”

Section: Local Anestheticsmentioning

confidence: 99%

“…In studies with this condition, treatment with topical diclofenac gel or solution achieved at least a 50% reduction in pain after 6 to 12 weeks, yielding an NNT of 9.8 (95% CI 7. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. The NNT for topical ketoprofen gel was 6.9 (95% CI 5.4-9.3).…”

Section: Nsaidsmentioning

confidence: 99%

Topical Drug Delivery in the Treatment of Chronic Pain: A Review

2024

Chron Pain Manag

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Chronic inflammatory or neuropathic pain are chronic syndromes poorly treated by commonly recommended systemic pharmacological therapies, partly due to dose-limiting side effects or adverse events. The use of topical therapeutics for chronic pain is growing and benefits from the reduced potential for adverse effects and the ability to target directly peripheral pathological processes. The current review identifies and describes the limitations of various commonly prescribed systemic pharmacological therapies for chronic inflammatory and neuropathic pain. It also justifies increased research to develop topical therapeutics for chronic pain, mainly localized inflammatory and neuropathic pain. The review discusses the various classes of topical treatments used for chronic pain, including agents that block sensory inputs; provide mechanism-based therapeutics; activate inhibitory systems; include combinations that produce multimodal therapeutic effects; and are targeted to mucosal tissues. It can be argued that current topical therapeutics for chronic pain rely too heavily on local anesthetics and capsaicinoids. More research is needed on multimodal topical therapies and/or targeted at the peripheral sources of pathology. Novel topical therapeutic development would also benefit from further research on topical co-drugs, drug-drug salts, cocrystal and hydrates, and ionic liquids.

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“…Several other modalities are used for episiotomy pain relief in addition to oral analgesics(paracetamol, nonsteroidal anti-inflammatory drug) such as epidural analgesia, prenatal perineal massage during the last 4 weeks of pregnancy [42], topical anesthetics [43] and paracervical block [37]. Even Vocal Distraction proves to be a powerful weapon against fear and pain in women [38].…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Pudendal nerve block versus usual lidocaine infiltration for pain relief in episiotomy repair: a comparative prospective study

Yasmine¹,

Melek²,

Ali³

et al. 2024

Ital J Gynaecol Obstet

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Objective. we aimed to compare the anesthetic and analgesic effect of the pudendal nerve block (PNB) and of the local lidocaine infiltration during episiotomy repair and in the following 24 hours.Patients and Methods. 70 parturients undergoing natural birth requiring episiotomy and presenting contraindication or refusal of epidural analgesia were randomized to receive pudendal nerve block with ropivacaine or local lidocaine infiltration. The main endpoint was: evaluation of obstetric analgesia by visual analogical scale . The secondary judgment criteria were: hemodynamic parameters, suture duration, onset time of sensory block, time to first analgesic request, rehabilitation parameters, parturient and obstetrician satisfaction and pain intensifying factors.Results. Mean VAS pain score was significantly lower in pudendal group versus infiltration group at T10min(10 minutes after local anesthetic injection) (

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Lidocaine-prilocaine cream versus local infiltration anesthesia in pain relief during repair of perineal trauma after vaginal delivery: a systematic review and meta-analysis

Abstract: This meta-analysis suggests that topical lidocaine-prilocaine cream gives comparable results in reducing pain during perineal repair after vaginal delivery.

Cited by 10 publications

References 25 publications

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

Topical Drug Delivery in the Treatment of Chronic Pain: A Review

Pudendal nerve block versus usual lidocaine infiltration for pain relief in episiotomy repair: a comparative prospective study

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