A PROSPECTIVE RANDOMISED CONTROLLED STUDY COMPARING THE EFFICACY OF 1% LIDOCAINE GEL AND 1% LIDOCAINE INFILTRATION IN REPAIR OF PERINEAL INJURY DURING CHILDBIRTH IN FEDERAL MEDICAL CENTRE, IDO – EKITI

Abstract

BACKGROUND: Episiotomy and spontaneous perineal injury repair following
vaginal delivery are common occurrences in obstetric practise.The potential
sequelae of obstetric perineal lacerations include acute postpartum perineal pain,
chronic perineal pain, dyspareunia, haematoma, infection of the wound
site,voiding problem.The literature contains little information on patient care after
onset of giving the iatrogenic or discovery of spontaneous perineal tear following
childbirth.
It is estimated that over 85% of women who have a vaginal delivery will sustain
some degree of perineal trauma, 60-70% of whom will require suturing. Pain
following perineal trauma can be severe and persist into the postpartum period. It
will inhibit normal daily activities such as walking, sitting and can influence
bounding with the newborn baby.
This was a prospective comparative study among healthy parturients at the
labour ward of the Department of Obstetrics and Gynaecology, Federal Medical
Centre, Ido – Ekiti.

OBJECTIVE: The study generally aimed to compare the efficacy of the 1%
Lidocaine cream and 1% Lidocaine infiltration in the repair of perineal injury
during childbirth. It specifically determined postpartum perineal pain
/discomfort amelioration by these two anaesthetic agents by estimating their pain
score; socio-demographic characteristics of the parturient; the pain score
/interval between completion of repair and the demand for additional analgesic
agent and overall expression of satisfaction by the parturient at the Federal
Medical Centre, Ido-Ekiti.

METHOD: A total number of eighty consecutive patients (forty in each arm) that
satisfied the inclusion criteria and gave consent in each group were recruited.
The two groups were randomized and study conducted in consecutive parturient
that had spontaneous vaginal delivery and had an episiotomy or perineal tear. A
group received 1% Lidocaine gel and the second group received 1% Lidocaine
infiltration for repair of selective perineal injury (first to second degree that
includes episiotomy).
RESULT: A total of eigthty women were studied, randomized into two groups of
forty each. The first group had the repair of perineal trauma after childbirth with
1% lidocaine gel second group had 1% lidocaine injection infiltration.
There was no significant difference across the age , parity, maternal weight,
gestational age at delivery, duration of labour and birth weight of babies
The pain score during the repair and at the demand for analgesia were higher
among the women that had 1% lidocaine injection compared with 1% lidocaine
gel for repair of their perineal trauma respectively (3.23 versus 2.83; p=0.268 and
3.05 versus 2.15; p=0.000).
Women who received 1% lidocaine gel application for repair of perineal
trauma were more satisfied compared with 1% lidocaine injection infiltration for
the same purpose (82.5% versus 75.0%; p=0.42), though not statistically
significant.
The mean pain score during the repair of the perineal trauma amongst the
primipara was 3.83±2.18, this was higher than the mean pain score for the
multipara of 2.80±1.33 , statistically significant at p-value of 0.014.
CONCLUSION: This clinically based research revealed that the use of 1%
lidocaine gel for repair of episiotomy and perineal trauma (1st and 2nd degree)
after childbirth gives satisfactory result for the women and surgeon. These are in
terms of low pain score, demand for analgesia by the mother and overall
expression of satisfaction by the parturients. Also the ease of administration of
the anaesthetic agent and repair of non-distorted wound edge for the surgeon.

A PROSPECTIVE RANDOMISED CONTROLLED STUDY COMPARING THE EFFICACY OF 1% LIDOCAINE GEL AND 1% LIDOCAINE INFILTRATION IN REPAIR OF PERINEAL INJURY DURING CHILDBIRTH IN FEDERAL MEDICAL CENTRE, IDO – EKITI