Effectiveness and acceptability of lidocaine spray in reducing perineal pain during spontaneous vaginal delivery: randomised controlled trial

Abstract

Objectives To evaluate the effectiveness and acceptability of a lidocaine spray in reducing perineal pain during spontaneous vaginal delivery. Design Randomised controlled trial. Setting Consultant led obstetric unit. Participants 185 women who had a spontaneous vaginal delivery without epidural analgesia. Interventions Topically applied local anaesthetic spray (93 women) and placebo spray (92 women). Main outcome measure Primary outcome measure was pain during delivery (0-100 scale). The 16 secondary outcome measures included second degree perineal trauma during delivery, trauma of the genital tract, and dyspareunia by two months. Results Lidocaine spray did not reduce pain during spontaneous vaginal delivery: mean 77 and 72 on a scale of 0-100 in the lidocaine and placebo groups, respectively (difference between means 4.8, 95% confidence interval − 1.7 to 11.2). Lidocaine spray may reduce genital tract trauma during delivery, in particular second degree perineal trauma. The intervention was highly acceptable to the women and midwives. Conclusions Although lidocaine spray applied to the perineum during spontaneous vaginal delivery did not reduce perineal pain, it was acceptable to both the women and the midwives. Trial registration Current controlled trials ISRCTN99732966.

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“…[28,29] Doğumun ikinci evresinde kullanılan anestezik spreylerin (lidokain) yüksek düzeyde ve az sayıda kanıtta, PT görülme oranını azalttığı, epizyotomiden kaynaklanan PA'nın ortadan kaldırılmasında etkin olduğu, lidokain jel'in postepizyotomi 48 saatten itibaren ağrıyı anlamlı oranda azalttığı ifade edilmiştir. [47,48] PT insidansında önemli olan etkenlerden biriside doğum pozisyonlarıdır. Cochrane sistematik incelemeye göre; doğum eyleminde tercih edilen dik pozisyonun (oturma, yarı rekümbent, diz çökme ve çömelme) operatif vaginal doğum insidansını azalttığı belirtilmiş [49] ve dik pozisyonlar iyi kalite A sınıfı öneri olarak gösterilmiştir.…”

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“…La protección manual del periné y la deflexión controlada de la cabeza fetal disminuyeron significativamente, de 4,03 a 1,17%, el número de desgarros del esfínter anal (117). El uso de la lidocaína en spray en la segunda etapa del parto en mujeres sin analgesia peridural no disminuyó el dolor perineal aunque hubo buena aceptación por las usuarias (118). El pujo dirigido comparado con pujos espontáneos durante el expulsivo disminuyó la capacidad vesical y la urgencia urinaria a los tres meses posparto (119).…”