The efficacy of topical lidocaine-prilocaine cream versus 2% lidocaine local infiltration in pain relief of episiotomy wound during postpartum: A randomized controlled trial

Abstract

Objectives: To investigate the efficacy of topical lidocaine-prilocaine cream and 2% lidocaine infiltration in pain relief of episiotomy wound during postpartum.

Materials and Methods: During September 24^th, 2022 to December 4^th, 2022, there were 779 pregnant women admitted to the labor room in Sanpasitthiprasong Hospital with spontaneous labor. After exclusion, 42 pregnant women were recruited into this study and randomized into two groups: 1) 2% lidocaine hydrochloride (HCl) infiltration (n=21) or 2) topical lidocaine-prilocaine cream application (n=21). Participants who were assigned to the 2% lidocaine HCl infiltration were injected at the perineum along the anticipated episiotomy site with 10 ml of 2% lidocaine 5 minutes before performing episiotomy. Another 10 ml of 2% lidocaine was injected at the episiotomy wound after delivery of the fetus. Participants who were assigned to the topical lidocaine-prilocaine cream group had 10 cm²-area of 10-gm cream applied outside of the perineal area when cervical dilatation was 9 cm or more. Another 10-gm of prilocaine-lidocaine cream was applied to the episiotomy wound either along the vaginal mucosal laceration or outside of the perineal skin after episiotomy and delivery of fetus. The baseline characteristics and clinical data of participants were obtained. The outcomes such as pain score using 10-cm visual analogue scale (VAS) were evaluated immediately after finishing episiorrhaphy and at 6, 12, 18, 24 hours postpartum. Need of additional analgesia, time to request for additional analgesia, level of activity-disturbing effect, level of worrying of episiotomy wound and level of satisfaction were compared.

Results: The total 42 multiparous women, gestational age of 37-42 weeks, with singleton fetus in cephalic presentation were included. There were comparable between groups in clinical, obstetric characteristics and labor progression. All participants had spontaneously vaginal delivery with mediolateral episiotomy to assist delivery of fetal head. With second degree perineal tear in all participants, the lidocaine prilocaine cream group had significant lower pain scores evaluated at 6, 18, and 24 hours postpartum when compared with lidocaine injection group but had no difference at immediately after finish suturing and 12 hours postpartum. There was no report of postpartum hemorrhage, puerperal infection, infected episiotomy wound, or side effects from the investigating drugs. There was no difference in birthweight and Apgar scores at 1, 5, 10 minutes of neonates between groups. There was no report of specific neonatal complications related to investigating drugs

Conclusions: Topical lidocaine-prilocaine cream applying at episiotomy wound was effective in pain relief of episiotomy wound in 24 hours postpartum without significant maternal and neonatal complications.