Fyneface-Ogan S, Mato C N, Enyindah C E
Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigena.
Niger J Med. 2006 Jan-Mar;15(1):77-80. doi: 10.4314/njm.v15i1.37123.
Episiotomy is the commonest obstetric surgical operation performed to increase the introitus to enhance vaginal delivery. This study was to compare the effect of two local anaesthetic agents on postpartum perineal pain and time for demand for oral analgesics.
A randomized double-blinded controlled clinical trial was conducted in primiparous women who had spontaneous vaginal delivery, comparing 1% plain lidocaine and 0.25% plain bupivacaine infiltration for the repair of selective episiotomy or perineal injury.
The two groups were comparable in sociodemographic characteristics. At 2 and 4 hours, women who had perineorraphy under lidocaine had significantly higher pain scores on the Visual Analogue Scale (VAS) than those who had the repair under bupivacaine, (4.0 v. 2.0)and(6.0 v. 3.0)respectively. At the 6h hour, the mean pain score for the bupivacaine group was 4.0 on the VAS while the lidocaine group had already received a dose of oral analgesic (Ibuprofen 400 mg) following severe pain from the repair. There was however no statistically significant difference in the pain score on the VAS between the two groups at the time of request for oral analgesics. The mean time lapse before demand for oral analgesics for the lidocaine group was 2.25 +/- 0.46 hrs (Mean+Standard deviation) while that for the bupivacaine group was 7.13 1.56 hrs (Mean Standard deviation). The P value was P < 0.0000 (Student's t-test) and statistically significant.
It is concluded that the patients in the bupivacaine group had a prolonged analgesia and needed fewer doses of oral analgesics in the immediate postpartum perineal repair period.
会阴切开术是最常见的产科外科手术，用于扩大阴道开口以促进阴道分娩。本研究旨在比较两种局部麻醉剂对产后会阴疼痛及口服镇痛药需求时间的影响。
对经阴道自然分娩的初产妇进行一项随机双盲对照临床试验，比较1%普通利多卡因和0.25%普通布比卡因浸润用于选择性会阴切开术或会阴损伤修复的效果。
两组在社会人口学特征方面具有可比性。在术后2小时和4小时，利多卡因下行会阴修补术的女性视觉模拟评分（VAS）疼痛评分显著高于布比卡因下行修补术的女性，分别为（4.0对2.0）和（6.0对3.0）。在术后6小时，布比卡因组VAS平均疼痛评分为4.0，而利多卡因组在修补术后因剧痛已服用一剂口服镇痛药（布洛芬400mg）。然而，在需要口服镇痛药时，两组VAS疼痛评分无统计学显著差异。利多卡因组口服镇痛药需求的平均时间间隔为2.25±0.46小时（均值±标准差），而布比卡因组为7.13±1.56小时（均值±标准差）。P值为P<0.0000（学生t检验），具有统计学显著性。
得出结论，布比卡因组患者在产后即刻会阴修补期间镇痛时间延长，口服镇痛药需求剂量减少。
