A Randomized, Double-Blind, Placebo-Controlled Trial of Epidural Morphine Analgesia After Vaginal Delivery

Macarthur, Alison; Imarengiaye, Charles; Tureanu, Luminita; Downey, Kristi

doi:10.1213/ane.0b013e3181c30f78

Cited by 16 publications

(6 citation statements)

References 17 publications

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“…Khajavi et al, showed that perineal pain were 96.4%, 63%, 25% and 12% in the first, tenth and fortieth and ninetieth day after birth, respectively. 5 Also, Macarthur et al, in the University of Toronto in Canada reported perineal pain 97% during 24 hours after delivery, 10 which is similar to Khajavi et al 5 In the present study, 98% of patients complained perineal pain in the first 24 hours after delivery ranging from 5-49 by McGill pain questionnaire which is similar to the other studies. 5,10 Thus, it seems that patients require more analgesic drugs within the first day after birth.…”

Section: Discussionsupporting

confidence: 89%

“…5 Also, Macarthur et al, in the University of Toronto in Canada reported perineal pain 97% during 24 hours after delivery, 10 which is similar to Khajavi et al 5 In the present study, 98% of patients complained perineal pain in the first 24 hours after delivery ranging from 5-49 by McGill pain questionnaire which is similar to the other studies. 5,10 Thus, it seems that patients require more analgesic drugs within the first day after birth. Regarding to the dose-dependent analgesic effect of chamomile, it seems that the dose used in this study for analgesic in the first 12 hours and the first day after birth was less than the needed dose.…”

Section: Discussionsupporting

confidence: 89%

“…10 Drug or non-drug methods are used to reduce the perineal pain. 3 Non-drug methods include using hot and cold compression, and salt water or diluted Savlone in the bathroom.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Chamomile Cream on Episiotomy Pain in Primiparous Women: A Randomized Clinical Trial

Aradmehr¹,

Azhari²,

Ahmadi³

et al. 2017

J Caring Sci

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Introduction: Episiotomy is a surgical incision made in the perineum to enlarge it. Perineal pain is the most common complaint of mothers after episiotomy. Chamomile extract has been proposed as a sedative in traditional medicine. This study was conducted to assess the effect of chamomile cream on the pain after episiotomy. Methods: This triple blind clinical trial was performed on 114 eligible women at Ommolbanin Hospital in Mashhad, Iran in 2014.They were randomly assigned to two groups using random blocks. After delivery, mothers in the intervention group used 0.5 g of prescribed chamomile while the control group used placebo cream on the stitch twice a day lasting ten days. Episiotomy pain was evaluated before intervention and 12 hours after episiotomy repair and also on the first, seventh, tenth and fourteenth day after delivery by McGill pain questionnaire. Data was analyzed by SPSS ver.13. Results: There was no significant difference between the two groups before the intervention, 12 hours and the first day after delivery. However, a significant difference was found on the seventh, tenth and fourteenth day after delivery. McGill mean (SD) score on the seventh, tenth and fourteenth in experimental group was 11.36 (5.04), 4.44 (3.43) and 7.16 (4.10) respectively. It was reported 14.88 (7.34), 7.41(4.92) and 9.96 (4.81) in placebo group, respectively. Conclusion: Chamomile cream can be used to reduce episiotomy pain in Primiparous us women.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

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The Effect of Chamomile Cream on Episiotomy Pain in Primiparous Women: A Randomized Clinical Trial

Aradmehr¹,

Azhari²,

Ahmadi³

et al. 2017

J Caring Sci

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“…There is scant previously published data available to allow establishment of norms for opioid utilization after vaginal delivery. Minassian et al 20 reported 76% of women with perineal laceration or episiotomy after vaginal delivery required opioids within first 48 hours, while Macarthur et al 21 reported incidences of opioid use during 24 hours after vaginal delivery of 7% in patients who received epidural morphine, and 32% in those not receiving epidural morphine. Our study highlights that the vast majority of patients undergoing vaginal delivery do not require opioids after discharge home.…”

Section: Discussionmentioning

confidence: 99%

Recovery after Nulliparous Birth

2017

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Background The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients. Methods A total of 213 nulliparous women were enrolled and assessed daily until they completed 3 outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery from delivery. The primary endpoint, pain- and opioid-free functional recovery, was the time required to reach all three of the endpoints. Pain burden was assessed as the area under the curve created by plotting the daily numerical pain rating scale against the days required to attain pain resolution. Times to attain study endpoints after cesarean delivery and vaginal delivery were compared using survival analysis. Results After vaginal delivery, days required for pain and opioid-free functional recovery (median [interquartile range (IQR)]) were 19 [11 to 26], for opioid cessation 0 [0 to 2], termination of all analgesic (including nonsteroidal antiinflammatories and acetaminophen) 11 [5 to 17], and pain resolution 14 [7 to 24]. Achievement of these endpoints after cesarean delivery required 27 [19 to 40], 9 [5 to 12], 16 [11 to 24], and 21 [14 to 27] days, respectively. Conclusions There is clinically significant variability between healthy nulliparous parturients in the pain experience, opioid use, and functional recovery after childbirth following vaginal and cesarean delivery. Recovery to predelivery function is similar after vaginal and cesarean delivery, and approximately half of the variance was explained by pain burden.

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“…La morphine péridurale permettait, dans ce contexte, une réduction d'environ 78 % des besoins analgé-siques par voie orale ou systémique au cours des premières 24h post-partum et facilite ainsi la mobilisation des patientes et leur réhabilitation. De nouvelles études devraient permettre de pouvoir cibler les sous-groupes les plus à risque de douleurs importantes et qui pourrait bénéficier de cette administration précoce de morphine péridurale (extractions instrumentales, lésions périnéales sévères) [61][62][63].…”

Section: Analgésie Multimodale Et Césarienneunclassified

Douleur et réhabilitation en post-partum

Rigouzzo

2015

Rev. med. perinat.

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La prise en charge optimale de la douleur est déter-minante pour permettre une réhabilitation dans la période péri-opératoire. Ces principes, bien connus en chirurgie, s'appliquent aux patientes après un accouchement par césa-rienne ou un accouchement par voie basse (AVB). En effet, si la césarienne a longtemps été considérée comme un modèle de douleur aiguë « reproductible », les douleurs aiguës après AVB ont été en grande partie sous-estimées, voire méconnues, et leur prise en compte en suites de couches est relativement récente. Les douleurs périnéales sont pourtant très fréquentes : leur durée et leur intensité sont corrélées à la gravité des lésions. Elles représentent une véri-table gêne à la réhabilitation post-partum.Pour le praticien, la réhabilitation post-partum centrée sur des stratégies analgésiques adaptées, devra également tenir compte des spécificités de la période post-partum que sont la facilitation de la relation mère-enfant, l'allaitement et la mise en oeuvre des soins au nouveau-né. Par-delà la réhabilitation post-partum immédiate, la prise en compte et le traitement de la douleur aiguë permettent également de prévenir l'émer-gence de douleurs chroniques et de syndromes dépressifs à distance de l'accouchement. L'incidence de ces derniers, non négligeable, est mieux connue aujourd'hui et semble indé-pendante du mode d'accouchement. Mots clés Douleur aiguë · Douleur chronique · Analgésie post-partum · RéhabilitationAbstract The optimal management of pain is crucial to facilitate perioperative rehabilitation. These well-known principles apply to patients after a cesarean section or a vaginal delivery. Indeed, if the cesarean has been considered as a reproducible model of acute pain, acute pain have been largely underestimated or ignored after vaginal delivery, and has been taken into account only recently. Perineal pain is indeed very common: duration and intensity are correlated with the severity of tissue damage. They may be an obstacle to postpartum rehabilitation.For the physician, post-partum rehabilitation focused on appropriate analgesic strategies should also take into account the specificities of the post-partum period which are motherchild relationship, breastfeeding facilitation and newborn care.Beyond the immediate postpartum rehabilitation, consideration and treatment of acute pain also prevent the emergence of persistent pain and post-partum depressions. Indeed, severity of acute post-partum pain but not mode of delivery is related to the risk of persistent pain and postpartum depressions.

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A Randomized, Double-Blind, Placebo-Controlled Trial of Epidural Morphine Analgesia After Vaginal Delivery

Cited by 16 publications

References 17 publications

The Effect of Chamomile Cream on Episiotomy Pain in Primiparous Women: A Randomized Clinical Trial

The Effect of Chamomile Cream on Episiotomy Pain in Primiparous Women: A Randomized Clinical Trial

Recovery after Nulliparous Birth

Douleur et réhabilitation en post-partum

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