| Research background:In the process of vaginal delivery,the vast majority of pregnant women will experience perineal lateral incision or perineal tear.Both perineal lateral incision and perineal tear need to be repaired after the delivery of the fetal placenta.The resulting perineal pain not only troubles women after delivery,affects early ambulation,urination and defecation and lactation,but also may develop into chronic pathological pain.Many literatures have reported that the vaginal incision or perineal tear and repair are accompanied by severe pain during vaginal delivery.Before perineal repair,lidocaine was traditionally used for local infiltration analgesia.However,the action time of lidocaine is only 30-60 minutes,but the perineal pain lasted at least 24 hours or longer.So local infiltration of lidocaine is not enough to eliminate perineal pain after vaginal delivery.Ropivacaine hydrochloride,a new anesthetic,is a long-acting local anesthetic with less cardiotoxicity than bupivacaine.It is widely used in intraspinal anesthesia and peripheral nerve block anesthesia,including pudendal nerve block.However,there is little information about the effect of infiltration anesthesia by using ropivacaine on lateral episiotomy or perineal repair.Some studies have found that local infiltration anesthesia with ropivacaine can effectively improve the pain after indirect inguinal hernia surgery.Of course,due to the special physiological changes of pregnant women,the analgesic effect of lateral perineal resection with ropivacaine is still unknown.Moreover,with the application of epidural labor analgesia in clinical practice,the perineal pain management in the delivery process has a positive significance to the perinatal physical and psychological health of pregnant women.For these reasons,this study used a randomized,controlled,double-blind method to observe the effects of ropivacaine and lidocaine infiltration on perineal pain after vaginal delivery with or without intraspinal analgesia,so as to provide an evidence for clinical application of local anesthetics.Objectives: To compare the analgesic effects of local anesthetics ropivacaine and lidocaine on perineal pain during vaginal delivery.Methods: This is a prospective,randomized,double-blind study.224 puerperae undergoing vaginal delivery were enrolled into this study in the maternity center in Southwest hospital from February 2016 to April 2017.224 puerpera were firstly divided into two groups: epidural labour analgesia group and non-epidural labour analgesia group,then they were randomly allocated into ropivacaine group or lidocaine group.Among them,there were 54 primipara and 58 pluripara women in non-epidural labour analgesia group.There were 92 primipara and 21 pluripara women in epidural labour analgesia group.In non-epidural labour analgesia group,their age was 30 ± 4 years old in the lidocaine group and 29 ± 3 years old in the ropivacaine group.Their weight was 68 ± 7 kg in the lidocaine group and 67 ± 8 kg in the ropivacaine group.In epidural labour analgesia group,their age was 29 ± 4 years old in the lidocaine group and 28 ± 3 years old in the ropivacaine group.Their weight was 66 ± 7 kg in the lidocaine group and 66 ± 11 kg in the ropivacaine group.0.75 % Ropivacaine or 1 % lidocaine infiltration was injected before performing of planned episiotomy or perineal repair,respectively.Visual analog scale(VAS)was used to rank perineal pain.Puerpera satisfactory was evaluated too.Results: In epidural labour analgesia group,the proportion of puerpera with VAS scoring equal to 0 was higher in the ropicavaine group compared with that in the lidocaine group at 1min(98% vs 86%,P=0.015)after injection,and 3 hour(100% vs 79%,P=0.0136),4 hour(96% vs 64%,P=0.0000),6 hour(86% vs 43%,P=0.0000),8 hour(75% vs 39%,P=0.0000),12 hour(64% vs 25%,P=0.0000),16hour(77% vs 41%,P=0.0001)and 24hour(75% vs 43%,P=0.0005)after delivery,respectively(P<0.05).In epidural labour analgesia group,the proportion of puerpera with VAS score of 0 in ropivacaine group was higher than that in lidocaine group when they were sitting up(59% vs 30%,P = 0.0023),urinating(66% vs 36%,P = 0.0013)and sleeping(91% vs 71%,P = 0.0077)after delivery.Maternal satisfaction with labor analgesia in ropivacaine group was higher than that in lidocaine group(54/56 vs 44/56,P=0.001).In non-epidural labour analgesia group,the proportion of puerpera with VAS scoring equal to 0 was higher in the ropicavaine group compared with that in the lidocaine group at 1min(91% vs 64%,P=0.0007)after injection,and 3hour(91% vs 73%,P=0.0136),4hour(84% vs 57%,P=0.0019)and 6hour(73% vs 54%,P=0.0031)after delivery,respectively(P<0.05).Maternal satisfaction with labor analgesia in ropivacaine group was higher than that in lidocaine group(52/56 vs 39/56,P=0.002).The vital signs during and after delivery between four sub-groups did not differ from each other significantly.There were no significant differences in Apgar score,umbilical artery and vein PH,BE,lactic acid content and hemoglobin content.Conclusion: Perineum infiltration with ropivacaine provide faster and longer duration of analgesia for perineal pain,and consequently,significantly improved the puerpera satisfaction after vaginal delivery compared with lidocaine infiltration regardless of presence or absence of epidural labour analgesia. |
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