Perineal infiltration with lidocaine 1%, ropivacaine 0.75%, or placebo for episiotomy repair in parturients who received epidural labor analgesia: a double-blind randomized study

Abstract

Background Episiotomies are performed in approximately 20% of vaginal deliveries and may result in postpartum pain. Perineal infiltration with lidocaine during the episiotomy is widely used, despite an early study showing no difference when compared with saline. Ropivacaine has increasingly been used in the obstetric setting, although not for episiotomies. We sought to compare the analgesic efficacy of ropivacaine, lidocaine or saline for perineal infiltration before repair of a mediolateral episiotomy in patients who delivered with epidural labor analgesia. Methods In this double-blind randomized prospective study, infiltration with 15 mL of 0.75% ropivacaine, 1% lidocaine, or saline was performed immediately before initiating the perineal repair. During the first 24 h, the time to the first oral analgesic, analgesic intake, visual analog scale scores for pain, and patient satisfaction scores were recorded. Results A total of 154 patients were included. Demographic data were comparable between the groups. Time to first oral analgesic request was 13.9 h with 0.75% ropivacaine, 17.0 h with 1% lidocaine, and 16.6 h with saline ( P = 0.104); the proportion of patients who did not request oral analgesics were 35%, 54% and 53%, respectively ( P = 0.09). Visual analog pain scores were low and not different between the three groups (ropivacaine 16.8 ± 11.6, lidocaine 12.4 ± 9.7; and saline 16.2 ± 11.5, P = 0.08). Conclusion For the first 24 h, perineal infiltration of ropivacaine, lidocaine, and saline were equivalent in producing post-episiotomy analgesia.