Клінічне дослідження ефективності гідрогелевих пов’язок із лідокаїном у зменшенні запалення епізіотомної рани, післяпологового стресу та болю

Abstract

Episiotomy, like other surgical interventions, triggers inflammatory responses within the physiological context by engaging proinflammatory mediators such as interleukins, cytokines, and prostaglandins. The painful experiences associated with episiotomy have the potential to significantly impact both the physical and emotional well-being of the parturient, particularly when considering individual variables such as the extent of the incision and the presence of complicating factors. In the postpartum period, the presence of fear, anxiety, and anticipation of pain may contribute to heightened stress levels, thereby exerting a profound impact on the emotional state of the parturient. Emotional stress, in turn, has the capacity to modulate pain perception, amplifying the discomfort associated with the incision. Elevated concentrations of stress hormones can influence immune responsiveness and inflammatory cascades, subsequently affecting the intricate process of episiotomy healing. Purpose - to examine determinants influencing the recovery of episiotomy wounds, encompassing inflammation markers, postpartum pain, and psychosocial stress. Materials and methods. A prospective randomized study analyzed clinical, laboratory, and historical data from 123 primiparous patients with episiotomy wounds at Kyiv City Maternity Hospital No. 5 during 2021-2022. The study comprised a comparison group (63 patients receiving standard treatment) and a research group (60 patients additionally utilizing hydrogel dressings with lidocaine). Both groups underwent assessment for heat shock protein Hsp60 and bacterial homolog GroEl levels, serum interleukin-6 dynamics, cortisol levels, pain, and stress levels according to the Edinburgh Postnatal Depression Scale. Statistical analysis employed the Mann-Whitney U test and EZR v. 1.54 statistical package. Results. No statistically significant differences were found in Hsp60 and GroEl levels, interleukin-6, cortisol, and pain levels after 24 hours between the comparison and research groups (p>0.05). However, interleukin-6 levels after 72 hours postpartum were 12.35 pg/ml (10.478-14.09) vs. 6.9 pg/ml (4.50-9.85); p<0.001; cortisol levels - 25.22 μg/dl (23.113-29.335) vs. 23.5 μg/dl (19.6-26.0), respectively; p<0.001. Pain levels by the visual analog scale after 72 hours postpartum were 4 (3-5) points vs. 3 (3-4) points; p<0.001; and at 10 days postpartum - 3 (2-3) points vs. 2 (2-3) points; p=0.010. Stress levels after 72 hours postpartum were 16 (13-19.75) points vs. 11.5 (9-15.5) points; p<0.001. Conclusions. Grasping the intricate interplay of episiotomy, inflammation markers, stress, and pain is pivotal for delivering comprehensive postpartum care. The implementation of evidence-based strategies, such as personalized pain management protocols, psychological support, and systematic monitoring of inflammation markers, can significantly enhance women's well-being and render the postpartum recovery process more comfortable. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.