Randomized trial of lidocaine ointment versus placebo for the treatment of postpartum perineal pain

Abstract

OBJECTIVE: To estimate the efficacy of lidocaine ointment in relieving pain after a vaginal delivery with an episiotomy or perineal laceration. METHODS: In a randomized, double-blind, placebo-controlled trial, 200 women received lidocaine ointment ( n = 108) or a placebo ( n = 92). Pain relief was assessed by the amount of ointment used (weight of jar before use − weight of jar after use), total number of pain pills used, and a pain questionnaire. The sample size was calculated using a β of .2 and an α of .05 with an expected reduction of other pain medications from an average use of six pills to four pills for the population. RESULTS: There was no significant difference in the amount of lidocaine versus placebo used for postpartum day 1 (5.1 g versus 4.0 g, respectively [ P = .13]) or day 2 (3.7 g versus 2.6 g, respectively [ P = .18]). Patients receiving lidocaine instead of the placebo showed no significant difference in the total amount of postpartum pain medications (6.3 versus 6.8 tablets, respectively [ P = .53]), subjective pain parameters ( P = .36), or satisfaction from ointment ( P = .99). Patients with an episiotomy used more pain medications than those with a laceration (7.9 versus 5.6 tablets, respectively [ P = .003]). Those with minor versus major lacerations required fewer pain pills (6.1 versus 10.8 tablets, respectively [ P < .001]) and used less ointment (4.3 g versus 7.9 g, respectively [ P = .02]) on the first postpartum day. CONCLUSION: Topical application of 5% lidocaine ointment was not effective in relieving episiotomy or perineal laceration pain.