Comparison of Wound Infiltration of Lidocaine with and without Ketorolac on Episiotomy Wound for Pain Management: A Randomized Double-Blinded Controlled Trial
Khwanwong W, MD1, Chanthasenanont A, MD1, Pongrojpaw D, MD1, Benchahong S, MD1, Bhamarapravatana K, PhD2, Suwannarurk K, MD1
Affiliation : 1 Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand 2 Department of Preclinic Science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : Episiotomy is performed in almost all spontaneous vaginal deliveries in Thailand. It is known to cause moderate
postpartum pain which has a negative effect on maternal quality of life. Lidocaine is used for relieving pain during the suturing. Local
anesthesia and NSAIDs such as ketorolac, are often used in many pain relieving procedures with positive results. The purpose of
this study is to investigate the pain reducing efficacy of combination of ketorolac and lidocaine during episiotomy comparing with
lidocaine alone.
Materials and Methods : Two hundred and forty healthy singleton parturients who had undergone spontaneous vaginal delivery at
the delivery room of Thammasat University Hospital were recruited. Participants were randomly assigned into two groups using
systemic random sampling. The allocation was assigned in sealed envelopes. First half is ketorolac group receiving 1% lidocaine
with 0.3% ketorolac (10 ml consisted of 100 mg and 30 mg of lidocaine and ketorolac tromethamine, respectively). Lidocaine group
received 1% lidocaine. Primary outcomes were pain score assessed immediately after birth 2, 6 and 24 hours postpartum by visual
analog scale (VAS). Postpartum complications were evaluated for secondary outcome.
Results : No statistical differences in demographic data and clinical characteristics were found in both study and control groups.
Mean VAS of the study group was statistically lower than that of the control group after perineal repair (3.32 vs. 4.43; p<0.001), 2
hours (3.08 vs. 4.08; p<0.001) and 6 hours postpartum (2.52 vs. 3.63; p<0.001), respectively. Four cases in each group had postpartum
hemorrhage. No case underwent peripartum hysterectomy.
Conclusion : Infiltration of ketorolac with lidocaine on episiotomy wound significantly reduced pain after perineal repair, 2 hours
and 6 hours postpartum compared with lidocaine alone. No significant differences in side effects and postpartum complication were
reported in both groups.
Keywords : Ketorolac, Lidocaine, Episiotomy, Local infiltration analgesia
