Effect of Ice Pack on Pain and Activities of Daily Living after Episiotomy: A Randomised Controlled Trial

Abstract

Introduction: Episiotomy is a common surgical procedure used during childbirth. Approximately 52% of women who have vaginal births undergo episiotomy, with 93.3% of primiparous women and 30.2% of multiparous women being affected. Perineal pain is a prevalent issue among mothers and can negatively impact their daily functioning and early experiences of motherhood. The use of an ice pack on the perineum is a simple, non pharmacological treatment for pain relief that may have an impact on postpartum recovery. However, no study has been conducted to determine the effect of an ice pack on postnatal mothers’ compliance with Activities of Daily Living (ADL) following episiotomy. Aim: To evaluate the effect of an ice pack on pain and ADL after episiotomy. Materials and Methods: This trial is an experimental, parallel, and assessor-blinded allocation with a computer-generated randomisation sequence. A randomised controlled trial conducted in the Department of Obstetrics and Gynaecology (OBG) at Justice KS Hegde Charitable Hospital in Deralakatte, Mangaluru, India. The study duration was one year, from March 2022 to March 2023. A total of 64 postnatal mothers (32 in each group) were included. This trial is an experimental, parallel, and assessorblinded allocation with a computer-generated randomisation sequence. The inclusion criteria were primiparous women aged between 18-35 years, who underwent episiotomy within 6 to 24 hours postpartum, delivered a live baby, complained of pain at the incision site, had a full-term labour, and had no other complications during pregnancy or labour. The participants were also required to be literate. Age, Numerical Pain Rating Scale (NPRS), and Barthel Index (BI) were compared between the groups using the independent sample t-test. The paired t-test was used for within group (pre to post-test) comparison of NPRS and Barthel index. A p-value of <0.05 was considered significant. Results: There was a significant difference in pain experienced by the groups, as assessed by NPRS (p<0.001). However, there was no difference in ADL between the groups (p>0.05). No side effects or harms were reported. Ice pack application, once daily for two days, was found to be safe and feasible for postepisiotomy patients. Conclusion: The current randomised controlled trial concludes that the application of an ice pack once daily for two days is significantly effective in reducing pain after episiotomy. However, it does not improve ADL in patients with post-episiotomy