Randomized Trial Comparing Three Methods of Perineal Skin Closure at the Time of Second Degree Repair [12E

Abstract

INTRODUCTION: We aimed to test the null hypothesis that there is no difference in patient pain among three different methods of perineal skin closure during second-degree repair: 1) suture, 2) no suture, and 3) surgical glue. METHODS: A single-blind randomized controlled trial of women post vaginal birth with a second-degree perineal laceration was conducted at a tertiary care teaching hospital August 2014-April 2017.Following repair of the deep tissues per standard fashion, women were randomized to perineal skin closure with suture, no suture or surgical glue using a 1:1:1 allocation. Pain was assessed using the McGill, 100-mm VAS and Present Pain Index at 1 day, 2 weeks and 6 weeks postpartum. RESULTS: 35 women were randomized: 14 received suture, 11 no suture and 10 had surgical glue. Demographics were similar between groups. At 2 weeks, women with suture had higher pain scores than those with surgical glue or no suture (McGill: suture vs glue vs no suture, 16.2 ± 9.9 vs 6.4 ± 8.4 vs 4.7 ± 5.8, ANOVA p = .021; VAS: 50.6 ± 31.7 vs 17.7 ± 25.7 vs 10.9 ± 12.2, ANOVA p=.009). At 6 weeks, pain scores remained higher with suture versus glue (McGill, p = .045) and no suture (VAS, p = .047). No difference in pain was seen between women with glue vs no suture. CONCLUSION: Compared to no suture and surgical glue, suturing the perineal skin was associated with the highest pain scores 6 postpartum weeks. Pain with surgical glue and no suture was similar.