Placement of Bupivacaine-soaked Spongostan in Episiotomy Bed Is Effective Treatment Modality for Episiotomy-associated Pain

Abstract

Study Objective To investigate the efficacy of placing bupivacaine-soaked Spongostan (Ferrosan, Soeborg, Copenhagen, Denmark) in episiotomy beds for relief of postpartum pain. Design Randomized, controlled study (Canadian Task Force classification I). Setting University medical school. Patients Women with mediolateral episiotomy. Interventions Patients were recruited and randomized into 2 groups by using a random number table. Group I (control group) received local lignocaine infiltration 1% up to 20 mL. For group II (Spongostan group), in addition to local lignocaine infiltration, bupivacaine-soaked Spongostan was placed in the episiotomy bed. All patients received routine postpartum perineal care in addition to the regular pain drugs (75 mg of diclofenac every 4 hours if needed). The primary outcome for the study was severity of pain, rated on a 10-cm visual analog scale from 0 to 10. Rating was recorded at 0, 1, 1.5, 2, 6, and 24 hours after delivery. Measurements and Main Results In all, 48 women were randomized to group I (local lignocaine alone) and 51 women to group II (local lignocaine plus Spongostan). The Spongostan and control groups were similar with respect to maternal age, parity, gestational age, maternal weight, and neonatal birth weight (p >.05; CI for difference: –2.6/10, 0.1/0.3, 0.3/0.7, 6.9/1.7, and –7/1.9, respectively). Episiotomy length (both vaginal and perineal) and episiotomy depth were higher in Spongostan group than control group (p <.05; 95% CI: –0.9/0, –0.8/–0.1, and –0.6/0, respectively). However, episiotomy reconstruction time of both groups was similar (p >.05; CI: 1.7/6.2). The pain score of Spongostan group was lower than control group and it was statistically significant at all time intervals (0, 1, 1.5, 2, 6, and 24 hours) between the Spongostan and control groups (p <.05; CI: 0.6/1.9, 1.1/2.4, 1.0/2.5, 0.9/2.4, 0.3/1.9, and 0.5/1.8, respectively). Postpartum total analgesic requirement (mg/person) again was significantly lower in the Spongostan group than control group (p <.01; CI: 0.1/0.4). Conclusion Placement of bupivacaine-soaked spongostan into the episiotomy bed resulted in decreased postpartum pain and drug requirement. It may be attributed to a higher drug concentration at episiotomy bed and prolonged drug effect.