Comparison of Wound Infiltration of Lidocaine with and without Dexamethasone on Episiotomy wound for Pain Management: A Randomized Double-Blinded Controlled Trial
Pawanna P, MD1, Chanthasenanont A, MD1, Pongrojpaw D, MD1, Limpivest U, MD1, Pattaraarchachai J, PhD2, Suwannarurk K, MD1
Affiliation : 1 Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand 2 Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
Background : Episiotomy was a surgical procedure at external genitalia for widening of the vaginal outlet during labor. It is known
to cause postpartum perineal pain and may have effects on quality of life.
Objective : The present study aimed to compare the analgesic effect of dexamethasone with lidocaine and lidocaine infiltration alone
during episiotomy. The primary and secondary outcomes were the analgesic efficacy and postpartum analgesic rescue, respectively.
Materials and Methods: Three hundred and sixty healthy singletons parturient who spontaneously delivered at Thammasat
University Hospital were recruited. Participants were randomly assigned into two groups using systemic random sampling. Local
infiltration of dexamethasone (4 mg) with lidocaine hydrochloride (100 mg) and lidocaine hydrochloride alone was performed in
study and control group, respectively. Pain score was assessed by numerical rating scale and recorded immediately after delivery
and after perineal repair, then again at 2-, 6- and 24-hours postpartum. The primary outcome was analgesic efficacy represented
by postpartum pain scores. The amount of postpartum acetaminophen consumption and postpartum complications were evaluated
for secondary outcome.
Results : Both study and control group had comparable demographic and clinical characters. Pain score by numerical rating scale
(NRS) of the study group was statistical lower than the control group at immediate after episiotomy wound repairing and 2 hours
postpartum. Both groups had equal pain intensity until 24 hours postpartum. Analgesic rescue during the first 24 hours after
delivery in the study group was lower than the control group (p = 0.025). There was no report of wound infection and serious side
effect.
Conclusion : Local infiltration of dexamethasone plus lidocaine before performing episiotomy gave a significant pain relief immediately
after perineal repair, 2 hours postpartum and decreased analgesic rescue requirement.
Keywords : Dexamethasone, Lidocaine, Episiotomy, Pain
