Deussen Andrea R, Ashwood Pat, Martis Ruth
Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, Level 1 QVB, 72 King William Street, North Adelaide, South Australia, Australia, 5006.
Cochrane Database Syst Rev. 2011 May 11(5):CD004908. doi: 10.1002/14651858.CD004908.pub2.
Women may experience differing types of pain and discomfort following birth, including cramping after birth pains associated with uterine involution.
To assess the effectiveness and safety of analgesia for relief of after birth pains following vaginal birth.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010) and the reference lists of trials and review articles.
All identified published and unpublished randomised controlled trials comparing two different types of analgesia or analgesia with placebo or analgesia with no treatment, for the relief of after birth pains following vaginal birth. Types of analgesia included pharmacological and non-pharmacological.
Two review authors assessed trial quality and extracted data independently.
We have included 18 studies (involving 1498 women) in this review. However, only nine of the included studies (with 750 women) reported 24 comparisons of analgesia with other analgesia or placebo and had data that could be included in our meta-analyses. The majority of studies investigated pharmacological analgesics and these were grouped into classes for this review. Non-steroidal anti-inflammatory drugs (NSAIDs) were significantly better than placebo at relieving pain from uterine involution as assessed by their summed pain intensity differences (SPID) (mean difference (MD) 4.34; 95% confidence interval (CI) 2.87 to 5.82; three studies, 204 women) and summed pain relief scores (MD 5.94; 95% CI 3.83 to 8.01; three studies, 204 women). NSAIDS were compared with opioids in one small study of 23 women reporting SPID and summed pain relief and found no difference. A larger study of 127 women found NSAIDs to be significantly better than opioids at reducing pain intensity six hours following study intervention (MD -0.70; 95% CI -1.04 to -0.35). Opioids were compared with placebo in three studies that could be included in meta-analyses; one small study of 23 women reporting SPID and summed pain relief and found no difference. One study of 95 women found no difference in pain intensity six hours following the study intervention. A third study of 108 women found significantly more women in the placebo group reported no pain relief than women in the opioid group (risk ratio 0.10; 95% CI 0.04 to 0.23). Aspirin was significantly better than paracetamol when pain intensity score was assessed six hours after study intervention (MD 0.85; 95% CI 0.29 to 1.41; one study 48 women) at relieving pain from uterine involution. Paracetamol was not better than placebo when pain intensity was assessed six hours after the study intervention in one study of 48 women.
AUTHORS' CONCLUSIONS: Non-steroidal anti-inflammatory drugs (NSAID) including aspirin were better than placebo at relieving pain from uterine cramping/involution following vaginal birth. NSAIDs were better than paracetamol and paracetamol was not better than placebo, though numbers of participants for these comparisons were small. Data for opioids compared with NSAIDs and opioids compared with placebo were conflicting, with some measures showing similar effect and others indicating NSAIDs were better than opioids and opioids were not better than placebo. There were insufficient data to make conclusions regarding the effectiveness of opioids at relieving pain from uterine cramping/involution.The median year of publication of included studies was 1981; therefore more research is needed to assess the effectiveness of current pharmacological and non-pharmacological analgesia at relieving pain from uterine cramping/involution following vaginal birth.
女性产后可能会经历不同类型的疼痛和不适，包括与子宫复旧相关的产后宫缩痛。
评估镇痛对缓解阴道分娩后产后疼痛的有效性和安全性。
我们检索了Cochrane妊娠与分娩组试验注册库（2010年12月31日）以及试验和综述文章的参考文献列表。
所有已识别的发表和未发表的随机对照试验，比较两种不同类型的镇痛方法，或镇痛与安慰剂，或镇痛与不治疗，以缓解阴道分娩后的产后疼痛。镇痛类型包括药物性和非药物性。
两位综述作者独立评估试验质量并提取数据。
本综述纳入了18项研究（涉及1498名女性）。然而，纳入的研究中只有9项（750名女性）报告了镇痛与其他镇痛方法或安慰剂的24项比较，且有可纳入我们荟萃分析的数据。大多数研究调查了药物性镇痛药，本综述将其分类。通过总疼痛强度差异（SPID）评估，非甾体抗炎药（NSAIDs）在缓解子宫复旧引起的疼痛方面明显优于安慰剂（平均差（MD）4.34；95%置信区间（CI）2.87至5.82；三项研究，204名女性）以及总疼痛缓解评分（MD 5.94；95%CI 3.83至8.01；三项研究，204名女性）。在一项23名女性的小型研究中比较了NSAIDs与阿片类药物，报告了SPID和总疼痛缓解情况，未发现差异。一项127名女性的更大规模研究发现，在研究干预6小时后，NSAIDs在减轻疼痛强度方面明显优于阿片类药物（MD -0.70；95%CI -1.04至-0.35）。在三项可纳入荟萃分析的研究中比较了阿片类药物与安慰剂；一项23名女性的小型研究报告了SPID和总疼痛缓解情况，未发现差异。一项95名女性的研究发现在研究干预6小时后疼痛强度无差异。第三项108名女性的研究发现，安慰剂组报告无疼痛缓解的女性明显多于阿片类药物组（风险比0.10；95%CI 0.04至0.23）。在研究干预6小时后评估疼痛强度评分时，阿司匹林在缓解子宫复旧引起的疼痛方面明显优于对乙酰氨基酚（MD 0.85；95%CI 0.29至1.41；一项研究，48名女性）。在一项48名女性的研究中，在研究干预6小时后评估疼痛强度时，对乙酰氨基酚并不优于安慰剂。
包括阿司匹林在内的非甾体抗炎药（NSAIDs）在缓解阴道分娩后子宫收缩/复旧引起的疼痛方面优于安慰剂。NSAIDs优于对乙酰氨基酚，而对乙酰氨基酚并不优于安慰剂，尽管这些比较的参与者数量较少。阿片类药物与NSAIDs比较以及阿片类药物与安慰剂比较的数据相互矛盾，一些指标显示效果相似，而另一些则表明NSAIDs优于阿片类药物，且阿片类药物并不优于安慰剂。关于阿片类药物缓解子宫收缩/复旧引起疼痛的有效性，数据不足无法得出结论。纳入研究的中位发表年份为1981年；因此，需要更多研究来评估当前药物性和非药物性镇痛在缓解阴道分娩后子宫收缩/复旧引起疼痛方面的有效性。
