VULVAR APPLICATION OF LIDOCAINE FOR PAIN RELIEF IN SPONTANEOUS VAGINAL DELIVERY

Objective: To evaluate the effect of topical perineal lidocaine on imm ediate postpartum perineal pain. Methods: Two hundred three volunteers randomly received either 2% lidocaine jelly or chlorhexidine gluconat e topically to the perineum during the second stage of labor in a doub le-blind study. A four-point analogue pain scale was used to rate peri neal pain 30 minutes after delivery. Parametric data were evaluated wi th the unpaired Student t test. Nonparametric data were analyzed using Mann-Whitney, Pearson chi(2), and Mantel-Haenzel tests, and forward s tepwise logistic regression. Results: Women receiving topical lidocain e reported less overall perceived pain (48%, P <.05) and less moderate to severe pain (52%, odds ratio 1.83, P <.04) at delivery than those receiving placebo (33 and 67%, respectively). The incidence of perinea l lacerations was similar in the two groups. A logistic regression fou nd topical lidocaine and multiparity as significant correlates of dimi nished peripartum pain (P <.007). Conclusions: Topical application of 2% lidocaine gel was associated with decreased pain perception in the immediate postpartum interval. If confirmed by other investigators, th is technique may offer improved analgesia while minimizing the injecti on route with local analgesia.