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Acute pain management after vaginal delivery with perineal tears or episiotomy.
Luxey, Xavier; Lemoine, Adrien; Dewinter, Geertrui; Joshi, Girish P; Le Ray, Camille; Raeder, Johan; Van de Velde, Marc; Bonnet, Marie-Pierre.
Afiliación
  • Luxey X; Anesthesiology and Intensive Care Medicine, Hôpital Armand-Trousseau, DMU DREAM, AP-HP, Paris, Île-de-France, France.
  • Lemoine A; Hôpital de la Timone service d'anesthésie réanimation 1, Marseille, Provence-Alpes-Côte d'Azur, France.
  • Dewinter G; Anesthesia, Intensive Care and Perioperative Medicine, Tenon Hospital, DMU DREAM, AP-HP, Paris, France.
  • Joshi GP; Biomedical Sciences Group, Department of Cardiovascular Sciences, Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium.
  • Le Ray C; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
  • Raeder J; Port Royal Maternity Unit, Cochin Hospital, Université Paris Cité, APHP, Paris, Île-de-France, France.
  • Van de Velde M; Centre for Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, INSERM, Paris, Île-de-France, France.
  • Bonnet MP; Institute of Clinical Medicine, department of Anesthesiology, Oslo University Hospital, Oslo, Norway.
Reg Anesth Pain Med ; 2024 Jun 14.
Article en En | MEDLINE | ID: mdl-38772634
ABSTRACT

BACKGROUND:

A vaginal delivery may be associated with acute postpartum pain, particularly after perineal trauma. However, pain management in this setting remains poorly explored.

OBJECTIVE:

The aim of this systematic review was to evaluate the literature and to develop recommendations for pain management after a vaginal delivery with perineal trauma. EVIDENCE REVIEW MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and systematic reviews assessing pain after a vaginal delivery with perineal tears or episiotomy until March 2023. Cochrane Covidence quality assessment generic tool and the RoB Vis 2 tool were used to grade the quality of evidence.

FINDINGS:

Overall, 79 studies (69 RCTs and 10 systematic reviews and meta-analyses) of good quality of evidence were included. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment. Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring. Local anesthetic infiltration, topical local anesthetic, ointment application, and pudendal nerve block are not recommended due to insufficient or lack of evidence. Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use. Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants. When a perineal suture is indicated, a continuous suture compared with an interrupted suture for the repair of episiotomy or second-degree perineal tears is recommended for the outcome of pain. For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain.

CONCLUSIONS:

Postpartum pain management after a vaginal delivery with perineal trauma should include acetaminophen, NSAIDs, and ice or chemical cold packs. Epidural morphine should be reserved for severe perineal tears. A surgical repair technique should depend on perineal tear severity.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Reg Anesth Pain Med Asunto de la revista: ANESTESIOLOGIA / NEUROLOGIA / PSICOFISIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Reg Anesth Pain Med Asunto de la revista: ANESTESIOLOGIA / NEUROLOGIA / PSICOFISIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido