Effectiveness and Acceptability of Lidocaine Spray in Reducing Perineal Pain During Spontaneous Vaginal Delivery: Randomized Controlled Trial

Abstract

Women planning spontaneous vaginal delivery often are not offered analgesia for perineal pain while in the second stage of labor. Midwives, however, sometimes apply various substances, including lidocaine, in an attempt to limit postpartum perineal pain. This study was a randomized, controlled trial comparing a topically applied local anesthetic spray with a placebo spray in 185 women having spontaneous vaginal delivery without epidural analgesia. The active and placebo solutions looked and smelled alike. The anesthetic solution was formulated to be equivalent to Xylocaine spray. Midwives were asked to apply 5 0.1-mL sprays to the perineum and the inside of the labia when birth appeared imminent but preferably at least 3 minutes beforehand. The actively treated and placebo-treated women were similar in most obstetric and sociodemographic characteristics. Women in both groups received 4.8 sprays on average. The intervals between treatment and delivery also were similar, approximating 11 to 12 minutes. Approximately 80% of women in each group delivered within 15 minutes of spraying. Pain scores, estimated using a 0 to 100 scale, were high and similar in the 2 groups. There was no evidence that the lidocaine spray lessened perineal pain, and it may even have increased it slightly. Fewer women in the active treatment group incurred second-degree perineal injuries. There were no third- or fourth-degree injuries. Women sprayed with lidocaine less often described dyspareunia when resuming sexual activity. Although acceptable to parturients, spraying the perineal region with a local anesthetic solution did not decrease postpartum pain. Further studies are needed to explore the reductions in second-degree perineal trauma and dyspareunia observed in women sprayed with lidocaine solution.