Reducing postnatal pain from perineal tears by using lignocaine gel: A double-blind randomized trial

Background: Perineal pain is one of the most common causes of maternal morb idity in the early puerperium. Several randomized trials have shown that to pical application of local anesthetics is effective in reducing postepisiot omy pain, but no randomized study has assessed the efficacy of local anesth etics for other perineal trauma. This study investigated if topically appli ed 2 percent lignocaine gel was an effective treatment for this group of wo men. Methods: A double-blind placebo controlled trial was conducted in a re gional reaching hospital in the northwest of England. One hundred and forty -nine women,cho had sustained a first- or second-degree tear were allocated by sealed envelopes to the lignocaine gel or placebo group. The primary ou tcome was self-reported pain at 24 hours postdelivery as measured on a nume rical rating sc alg (pain score). Secondary outcomes included pain scores a t 48 hours, the need for oral analgesia, and maternal satisfaction. Based o n a pilot study, we calculated that 128 women were required to detect a 25 percent difference in pain scores between the two groups with 80 percent po wer (alpha = 0.05). The pain scores of women in each trial arm were compare d using the unpaired t rest and 95 percent confidence intervals. Results: W omen using lignocaine gel had lower average pain scores, although this only reached statistical significance at 48 hours after delivery (p = 0.023). I n general, women liked using the study gel. No difference was found in cons umption of oral analgesia. Conclusions: This study suggested that lignocain e gel may be effective on the second postnatal day. Further research is req uired to assess the optimum timing of this intervention and the population that would most benefit from its use.