Hedayati H, Parsons J, Crowther C A
Cochrane Database Syst Rev. 2003(3):CD003931. doi: 10.1002/14651858.CD003931.
Perineal pain from a tear and/or surgical cut (episiotomy) is a common problem following vaginal birth. Strategies to reduce perineal trauma and the appropriate repair of any perineal damage sustained are important for avoiding and alleviating pain. Where pain is present, numerous treatments are used in clinical practice, such as local anaesthetics, oral analgesics, therapeutic ultrasound, antiseptics and non-pharmacological applications such as ice packs and baths. This review assesses the evidence for using rectal analgesia for pain relief following perineal trauma.
To assess the effectiveness of analgesic rectal suppositories for pain from perineal trauma following childbirth.
We searched the Cochrane Pregnancy and Childbirth Group trials register (July 2002), CENTRAL (The Cochrane Library, Issue 2, 2002), CINAHL (May 2002) and MIDIRS (May 2002).
Randomised controlled trials comparing analgesic rectal suppositories with placebo or alternative treatment for the relief of perineal pain.
Two reviewers assessed trial quality and extracted data independently.
Three trials involving 249 women met the inclusion criteria. Only two of the trials identified for inclusion in this review had data that could be entered in a meta-analysis, with the third not providing data in a useable format. Women were less likely to experience pain at or close to 24 hours after birth if they received non-steroidal anti-inflammatory drugs (NSAID) suppositories compared with placebo (relative risk (RR) 0.37, 95% confidence interval (CI) 0.10 to 1.38, 2 trials, 150 women). Women in the NSAID suppositories group compared with women in the placebo group required less additional analgesia in the first 24 hours after birth (RR 0.31, 95% CI 0.17 to 0.54, 1 trial, 89 women) and this effect was still evident at 48 hours postpartum (RR 0.63, 95% CI 0.45 to 0.89, 1 trial, 89 women). No information was available on pain experienced more than 72 hours after birth or other outcomes of importance to women such as the impact on daily activities, resumption of sexual intercourse and the impact on the mother-baby relationship.
REVIEWER'S CONCLUSIONS: NSAID rectal suppositories are associated with less pain up to 24 hours after birth, and less additional analgesia is required. More research is required regarding long-term effects and maternal satisfaction with the treatment.
分娩时因会阴撕裂和/或手术切口（会阴切开术）导致的会阴疼痛是阴道分娩后常见的问题。减少会阴创伤的策略以及对任何会阴损伤进行适当修复对于避免和减轻疼痛很重要。当出现疼痛时，临床实践中会使用多种治疗方法，如局部麻醉剂、口服镇痛药、治疗性超声、防腐剂以及冰袋和坐浴等非药物应用。本综述评估了使用直肠镇痛缓解会阴创伤后疼痛的证据。
评估分娩后用于缓解会阴创伤疼痛的直肠镇痛栓剂的有效性。
我们检索了Cochrane妊娠与分娩组试验注册库（2002年7月）、Cochrane系统评价数据库（2002年第2期）、护理学与健康领域数据库（2002年5月）和助产士信息资源数据库（2002年5月）。
比较直肠镇痛栓剂与安慰剂或其他治疗方法缓解会阴疼痛的随机对照试验。
两名评价员独立评估试验质量并提取数据。
三项涉及249名女性的试验符合纳入标准。在本综述中确定纳入的试验中，只有两项试验的数据可用于荟萃分析，第三项试验未提供可用格式的数据。与安慰剂相比，接受非甾体抗炎药（NSAID）栓剂的女性在出生后24小时或接近24小时时疼痛的可能性较小（相对危险度（RR）0.37，95%置信区间（CI）0.10至1.38，2项试验，150名女性）。与安慰剂组的女性相比，NSAID栓剂组的女性在出生后的前24小时需要的额外镇痛较少（RR 0.31，95%CI 0.17至0.54，1项试验，89名女性），并且这种效果在产后48小时仍然明显（RR 0.63，95%CI 0.45至0.89，1项试验，89名女性）。关于出生后72小时以上经历的疼痛或对女性重要的其他结局，如对日常活动的影响、恢复性生活以及对母婴关系的影响，没有可用信息。
NSAID直肠栓剂与出生后24小时内疼痛减轻以及所需额外镇痛较少有关。需要更多关于长期影响和母亲对治疗满意度的研究。
