Is Rectal Analgesia a Better Choice for Post Episiotomy Pain? - An Interventional Study
Abstract
Background: Post episiotomy pain is accompanied by discomforts while walking, sitting and even while squatting. Managing the perineal pain is essential for a smooth transition into motherhood for any parous women. Many non-pharmacological remedies exist and are practiced yet use of analgesics are the first line of management to relieve pain.
Purpose: This study aimed to evaluate the effectiveness of rectal analgesic suppository among the interventional group (n=15) and the control group (n=15) with routine oral analgesics among primipara woman. Quantitative Approach using Posttest with control group design was used. Simple random sampling was done for randomization of samples.
Result: The study found that there was a significant reduction in pain among the rectal analgesia group when compared to the oral analgesic groups. The post-test pain scores were significantly lower in the experimental group than the control group. It was also observed that there were lesser discomforts experienced while doing their activities of daily living including breastfeeding the baby in sitting position among primipara women in the interventional group than the primipara women in the control group.
Conclusion: Using rectal analgesics for post episiotomy pain is safe and comfortable and helps manage pain better and should be included in the hospital’s pain management protocol for pain relief immediately post episiotomy.
How to cite this article:
Francis F, Rosemol MA. Is Rectal Analgesia a Better Choice for Post Episiotomy Pain? - An Interventional Study. Int J Nurs Midwif Res 2019; 6(2&3): 62-68.
References
Declercq E, Cunningham D, Johnson C et al. mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey. Birth 2008; 35(1): 16-24. Available from: http://www. gr8birth.com/cesarean/18.pdf [DOI: 10.1111/j.1523- 536x.2007.00207.x/ PubMed/ Google Scholar/ ResearchGate].
Kalis V, Landsmanova J, Bednarova B et al. Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. International Journal of Gynecology & Obstetrics 2011; 112(3): 220-224. Available from: https://obgyn.onlinelibrary.wiley.com/doi/ abs/10.1016/j.ijgo.2010.09.015 [DOI: https://doi. org/10.1016/j.ijgo.2010.09.015/ PubMed/ Google Scholar/ ResearchGate].
Kalis V, Laine K, de Leeuw J et al. Classification of episiotomy: towards a standardization of terminology. BJOG: An International Journal of Obstetrics & Gynaecology 2012; 119(5): 522-526. Available from: https://obgyn.onlinelibrary.wiley.com/doi/ full/10.1111/j.1471-0528.2011.03268.x [DOI: 10.1111/j.1471-0528.2011.03268.x/ PubMed/ Google Scholar].
Karbanova J, Rusavy Z, Betincova L et al. Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy. International Journal of Gynecology & Obstetrics 2014; 127(2): 152-156. Available from: http://www. komora-primalja.hr/datoteke/Karbanova%20J%20 2014%20Clinical%20evaluation%20of%20early%20 postpartum%20pain%20and%20%20healing%20 outcomesg.pdf [DOI: 10.1016/j.ijgo.2014.05.025. / PubMed/ Google Scholar].
Al-Ghammari K, Al-Riyami Z, Al-Moqbali M et al. Predictors of routine episiotomy in primigravida women in Oman. Applied Nursing Research 2016; 29: 131- 135. Available from: https://www.sciencedirect.com/ science/article/pii/S0897189715001007?via%3Dihub [DOI: https://doi.org/10.1016/j.apnr.2015.05.002/ PubMed/ Google Scholar/ ResearchGate].
Hartmann K, Viswanathan M, Palmieri R et al. Outcomes of routine episiotomy: a systematic review. JAMA 2005; 293(17): 2141. Available from: https://jamanetwork. com/journals/jama/fullarticle/200799 [DOI: https:// doi.org/10.1001/jama.293.17.2141/ PubMed/ Google Scholar/ Researchgate].
Norderval S, Nsubuga D, Bjelke C et al. Anal incontinence after obstetric sphincter tears: incidence in a Norwegiancounty. Acta Obstetricia Et Gynecologica Scandinavica 2004; 83(10): 989-994. Available from: [DOI: https:// doi.org/10.1111/j.0001-6349.2004.00647.x/ PubMed/ Google Scholar/ ResearchGate].
Sioutis D, Thakar R, Sultan A. Overdiagnosis and rising rate of Obstetric Anal Sphincter Injuries (OASIS): time for reappraisal. Ultrasound in Obstetrics & Gynecology 2017; 50(5): 642-647. Available from: https://obgyn. onlinelibrary.wiley.com/doi/pdf/10.1002/uog.17306 [PubMed/ Google Scholar].
Clesse C, Lighezzolo-Alnot J, De Lavergne S et al. Statistical trends of episiotomy around the world: Comparative systematic review of changing practices. Health Care for Women International 2018; 39(6): 644- 662. Available from: https://www.tandfonline.com/doi/ abs/10.1080/07399332.2018.1445253 [DOI: https:// doi.org/10.1080/07399332.2018.1445253/ PubMed/ Google Scholar/ ResearchGate].
Kropp N, Hartwell T, Althabe F. Episiotomy rates from eleven developing countries. International Journal of Gynecology & Obstetrics 2005; 91(2): 157-159. Available from: https://obgyn.onlinelibrary.wiley.com/ doi/abs/10.1016/j.ijgo.2005.07.013 [DOI: https://doi. org/10.1016/j.ijgo.2005.07.013/ PubMed/ Google Scholar/ ResearchGate].
Pitangui AC, de Sousa L, Gomes FA et al. High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: A randomized, controlled trial. Journal of Obstetrics and Gynaecology Research 2012; 38(7): 980-987. Available from: https://s3.amazonaws.com/ academia.edu.documents/43371011/High-frequency_ TENS_in_post-episiotomy_p20160304-17431-1e4ltzx. pdf?response-content-disposition=inline%3B%20 filename%3DHigh-frequency_TENS_in_postepisiotomy_ p.pdf&X-Amz-Algorithm=AWS4-HMACSHA256& X-Amz-Credential=AKIAIWOWYYGZ2Y53 UL3A%2F20191112%2Fus-east-1%2Fs3%2Faws4_ request&X-Amz-Date=20191112T103322Z&X-Amz- Expires=3600&X-Amz-SignedHeaders=host&X-Amz-Si gnature=b82caced267441c12fc7faf91c9585d6a7e2 2f3789573d12560ed45776f504ff [DOI: https://doi. org/10.1111/j.1447-0756.2011.01824.x/ PubMed/ Google Scholar].
Dutra L, Araújo A, Micussi M. Non-pharmacological therapies for postpartum analgesia: a systematic review. Brazilian Journal of Pain 2019; 2(1): 72-80. Available from: http://www.scielo.br/pdf/brjp/v2n1/2595-0118- brjp-02-01-0072.pdf [Google Scholar].
Campbell JN. The fifth vital sign revisited. Pain 2016; 157(1): 3-4. [PubMed/ Google Scholar].
East C, Sherburn M, Nagle C et al. Perineal pain following childbirth: Prevalence, effects on postnatal recovery and analgesia usage. Midwifery 2012; 28(1): 93-97. Available from: https://s3.amazonaws. com/academia.edu.documents/47096504/j. midw.2010.11.00920160707-1677-rdmagg. pdf?response-content-disposition=inline%3B%20 filename%3DPerineal_pain_following_childbirth_ Preva.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&XAmz- Credential=AKIAIWOWYYGZ2Y53UL3A%2F2019 1112%2Fus-east-1%2Fs3%2Faws4_request&X-Amz- Date=20191112T111828Z&X-Amz-Expires=3600&XAmz- SignedHeaders=host&X-Amz-Signature=ad0cd e4d6eab6ec96844909b2654663a3c411d22dfe891 fa42f1cfe0b642f426 [PubMed/ Google Scholar].
Sheikhan F, Jahdi F, Khoei E et al. Episiotomy pain relief: Use of Lavender oil essence in primiparous Iranian women. Complementary Therapies in Clinical Practice 2012; 18(1): 66-70. Available from: https://s3.amazonaws.com/academia.edu. documents/58422773/maternitas_lavender1. pdf?response-content-disposition=inline%3B%20 filename%3DMaternitas_lavender_1.pdf&X-Amz- Algorithm=AWS4-HMAC-SHA256&X-Amz-Crede ntial=AKIAIWOWYYGZ2Y53UL3A%2F20191112 %2Fus-east-1%2Fs3%2Faws4_request&X-Amz- Date=20191112T112459Z&X-Amz-Expires=3600&XAmz- SignedHeaders=host&X-Amz-Signature=1f2 c30e70a2f0e4855906245cbcf9a003c3f393f368bf7 98db356833a1925baf [PubMed/ Google Scholar/ ResearchGate].
Santos J, de Oliveira S, da Silva F et al. Low-level laser therapy for pain relief after episiotomy: a double-blind randomised clinical trial. Journal of Clinical Nursing 2012; 21(23-24): 3513-3522. Available from: https:// onlinelibrary.wiley.com/doi/abs/10.1111/j.1365- 2702.2011.04019.x [DOI: https://doi.org/10.1111/ j.1365-2702.2011.04019.x/ PubMed/ Google Scholar/ ResearchGate].
Mahishale A, Chougala A, Patted S. Effect of therapeutic ultrasound and maternal cooling gel pad for perineal pain following vaginal delivery with episiotomy. Journal of Womens Health Care 2013; 2: 3. Available from: https://www.longdom.org/open-access/effect-oftherapeutic- ultrasound-and-maternal-cooling-gelpad- for-perineal-pain-following-vaginal-delivery-withepisiotomy- 2167-0420-1000128.pdf [DOI: https://doi. org/10.4172/2167-0420.1000128/ Google Scholar/ ResearchGate].
Aradmehr M, Azhari S, Ahmadi S et al. The effect of chamomile cream on episiotomy pain in primiparous women: a randomized clinical trial. Journal of Caring Sciences 2017; 6(1): 19-28. [DOI: https://doi. org/10.15171/jcs.2017.003/ PubMed/ Google Scholar].
Marra C, Pozzi I, Ceppi L et al. Wrist-ankle acupuncture as perineal pain relief after mediolateral episiotomy: a pilot study. The Journal of Alternative and Complementary Medicine 2011; 17(3): 239-241. [PubMed/ Google Scholar/ ResearchGate].
Wilasrusmee S, Chittachareon A, Jirasiritum S et al. Naproxen suppository for perineal pain after vaginal delivery. Obstetric Anesthesia Digest 2009; 29(2): 100-101. [DOI: https://doi.org/10.1097/01. aoa.0000350641.18538.7e PubMed/ Google Scholar/ ResearchGate].
Bar-Oz B, Bulkowstein M, Benyamini L et al. Use of antibiotic and analgesic drugs during lactation. Drug Safety 2003; 26(13): 925-935. [PubMed/ Google Scholar/ ResearchGate].
Alvarenga MB, Francisco AA, de Oliveira SMJV et al. Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability. Rev Latino-Am Enfermagem [Internet]. 2015; 23(1): 162-168. [DOI: https://doi.org/10.1590/ 0104-1169.3633.2538/ PubMed/ Google Scholar/ ResearchGate].
Way S. A qualitative study exploring women’s personal experiences of their perineum after childbirth: Expectations, reality and returning to normality. Midwifery 2012; 28(5): e712-9. Available from: https://www.midwiferyjournal.com/article/ S0266-6138(11)00127-6/fulltext [DOI: https://doi. org/10.1016/j.midw.2011.08.011/ PubMed/ Google Scholar/ ResearchGate].
Dasanayake D. A randomized controlled trial of rectal analgesia diclofenac sodium for relief of perineal pain following child birth. Sri Lanka Journal of Obstetrics and Gynaecology 2014; 36(1): 14-16. Available from: https://sljog.sljol.info/articles/abstract/10.4038/ sljog.v36i1.6962/ [DOI: http://doi.org/10.4038/sljog. v36i1.6962/ Google Scholar/ ResearchGate].
Yildizhan R, Yildizhan B, Sahin S et al. Comparison of the efficacy of diclofenac and indomethacin suppositories in treating perineal pain after episiotomy or laceration: a prospective, randomized, double-blind clinical trial. Archives of Gynecology and Obstetrics 2009; 280(5): 735-738. Available from: https://link.springer.com/ article/10.1007%2Fs00404-009-1006-3 [PubMed/ Google Scholar/ ResearchGate].
Hedayati H, Parsons J, Crowther C. Rectal analgesia for pain from perineal trauma following childbirth. Cochrane Database of Systematic Reviews, 2003. Available from: https://www.cochranelibrary.com/cdsr/ doi/10.1002/14651858.CD003931/full [DOI: https:// doi.org/10.1002/14651858.CD003931/ PubMed/ Google Scholar/ ResearchGate].
Dodd J, Hedayati H, Pearce E et al. Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories. BJOG: An International Journal of Obstetrics and Gynaecology 2004; 111(10): 1059-1064. Available from: https:// obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471- 0528.2004.00156.x?sid=nlm%3Apubmed [DOI: https:// doi.org/10.1111/j.1471-0528.2004.00156.x/ PubMed/ Google Scholar/ ResearchGate].
