Topically applied anaesthetics for treating perineal pain after childbirth

Not enough evidence to say if local anaesthetics applied to the perineum help to relieve perineal pain after childbirth.

The perineum is the area between a woman's vagina and rectum, which may be traumatised during childbirth following a tear or a surgical cut (episiotomy). Local anaesthetics are easy to use and inexpensive, but their effectiveness needs to be assessed. This review of trials found eight studies using a variety of anaesthetics. There were not enough data to say if they helped with pain, and long-term effects were not assessed. More research is required to assess the effectiveness of topical anaesthetics on pain, longer-term outcomes, relationships and quality of life, as well as the effectiveness of different topical anaesthetics.

Authors' conclusions: 

Evidence for the effectiveness of topically applied local anaesthetics for treating perineal pain is not compelling. There has been no evaluation for the long-term effects of topically applied local anaesthetics.

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Background: 

Perineal trauma is a major problem affecting millions of women around the world each year. The degree of perineal pain and discomfort associated with perineal trauma is often underestimated. Pain often interferes with basic daily activities for the woman such as walking, sitting and passing urine and also negatively impacts on motherhood experiences.

Objectives: 

To assess the effects of topically applied anaesthetics for relief of perineal pain following childbirth whilst in hospital and following discharge.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2007).

Selection criteria: 

Randomised controlled trials comparing topically applied anaesthetic with no treatment, placebo or alternative treatment.

Data collection and analysis: 

Two authors independently assessed trial eligibility and quality and double-entered the data. We contacted study authors for additional information.

Main results: 

Eight trials made up of 976 women were included in the review. Five of these trials measured pain experienced up to 24 hours after birth but different methods to assess pain were used in each of the studies. All five trials showed no difference in pain relief when the topical anaesthetic was compared with placebo. One of these studies looked at topical anaesthetics compared with indomethacin vaginal suppositories but there was no significant difference in mean pain scores. All trials reported only short-term follow up (up to four days). Two trials looked at additional analgesia taken for perineal pain, with one trial finding that less additional analgesia was required with epifoam use in comparison with placebo (relative risk (RR) 0.58, 95% confidence interval (CI) 0.40 to 0.84, one trial, 97 women). However, lignocaine/lidocaine showed no difference with regard to additional analgesia use. Adverse effects were not formally measured in the studies; however, some studies commented that there were no side-effects severe enough to discontinue treatment. One study found that the women in the treatment group were more satisfied than the placebo group (RR 0.09, 95% CI 0.01 to 0.65, one trial, 103 women).

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