Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period

Abstract

In women who are not breastfeeding and who sustained perineal trauma, NSAIDs (compared to placebo) provide greater pain relief for acute postpartum perineal pain and fewer women need additional analgesia when treated with a NSAID. However, the risk of bias was unclear for many of the included studies, adverse effects were often not assessed and breastfeeding women were not included in the studies. The overall quality of the evidence (GRADE) was low with the evidence for all outcomes rated as low or very low. The main reasons for downgrading were inclusion of studies with high risk of bias and inconsistency of findings of individual studies.NSAIDs also appear to be more effective in providing relief for perineal pain than paracetamol, but few studies were included in this analysis.Future studies should examine NSAIDs' adverse effects profile including neonatal adverse effects and the compatibility of NSAIDs with breastfeeding, and assess other important secondary outcomes of this review. Moreover, studies mostly included women who had episiotomies. Future research should consider women with and without perineal trauma, including perineal tears. High-quality studies should be conducted to further assess the efficacy of NSAIDs versus paracetamol and the efficacy of multimodal treatments.

Pharmacologic Therapy in Postpartum Pelvic Pain Management

“…A 2016 systematic review concluded that NSAIDs appear to be more effective than acetaminophen at 4 hours after birth (relative risk, 1.54; 95% CI, 1.07-2.22), but there is no significant difference at 6 hours after birth [9]. However, the results of our study underline the fact that women with episiotomy had more Paracetamol vials than women without episiotomy while the consumption of other analgetics was similar.…”

“…Lately, the focus has been set on single dose therapy effectiveness and studies have shown that a single dose of acetaminophen (500-1.000 mg) or an NSAID relieves pain better than placebo [9,10].…”

Untitled

“…Moreover, other options include aspirin or local application of cooling treatments. A systematic review with 35 randomized clinical trials in non-breastfeeding women showed that a single oral dose of non-steroidal anti-inflammatory drug compared to placebo, was better in relieving pain at 4 (1.91,95% CI 1.64-2.23) and 6 hours (RR 1.92,95% CI 1.69-2.17); and decrease additional drug administration at 4 (RR 0.39,95% CI 0.26-0.58) and 6 hours (RR 0.32,95% CI 0.26-0.40) Besides NSAIDs were superior compared with paracetamol [10]. Shepherd et al in a systematic review that included 17 RCTs compared a single dose of aspirin against placebo for pain relief, aspirin showed superiority (RR 2.03,95% CI 1.69-2.4).…”

Das frühe Wochenbett – Physiologie und Pathologie

“…Insbesondere Multipara leiden in den ersten Tagen unter der raschen Kontraktion des Uterus und geben vermehrt Unterbauchschmerzen insbesondere nach dem Stillen an. In solchen Fällen sind vor allem die nichtsteroidalen Antirheumatika (NSAID), wie Ibuprofen und Diclofenac-Suppositorien, effektiv und sollten bei unauffälliger Nierenfunktion eingesetzt werden [30]. Zusätzlich werden diese häufig mit gutem Erfolg mit Paracetamol kombiniert [31].…”