College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
J Gynecol Obstet Hum Reprod. 2021 Oct;50(8):102074. doi: 10.1016/j.jogoh.2021.102074. Epub 2021 Jan 27.
To systematically and meta-analytically examine the efficacy of ropivacaine versus lidocaine infiltration for controlling postpartum perineal pain secondary to spontaneous tear or selective episiotomy.
We searched four databases from inception to 20-September-2020. We included all relevant randomized and nonrandomized studies and assessed their risk of bias. We pooled data as standardized mean difference (SMD), weighted mean difference (WMD), or odds ratio (OR) with 95 % confidence intervals (95 % CIs).
Four studies met the inclusion criteria (one and three studies were nonrandomized and randomized, respectively). There were 405 patients; 205 and 200 patients received lidocaine and ropivacaine, respectively. There was no significant difference between ropivacaine and lidocaine groups with regard to visual analogue scale (VAS) pain scores at suturing (WMD = -0.04, 95 % CI [-0.41, 0.32], P = 0.82), 2 h (SMD = -1.50, 95 % CI [-3.50, 0.50], P = 0.14), and 24 h (SMD = -0.40, 95 % CI [-1.15, 0.34], P = 0.29) post repair of perineal trauma. Proportion of patients with mild VAS pain score ≤3 at 24 h was significantly higher in the ropivacaine group (OR = 4.34, 95 % CI [2.03, 9.29], P < 0.001). Proportion of patients who did not require additional analgesia during the first 24 h post perineal repair did not significantly differ between both groups (OR = 2.44, 95 % CI [0.09, 68.21], P = 0.60). Ropivacaine group achieved higher maternal satisfaction (OR = 7.13, 95 % CI [3.63, 13.99], P < 0.001).
During repair of postpartum perineal trauma, pain efficacy is relatively longer with ropivacaine but safety is not well investigated. High-quality and large-sized studies are needed to consolidate these findings.
系统地和荟萃分析评估罗哌卡因与利多卡因浸润对控制自发性撕裂或选择性会阴切开术后产后会阴疼痛的疗效。
我们从建立数据库至 2020 年 9 月 20 日检索了四个数据库。我们纳入了所有相关的随机和非随机研究，并评估了它们的偏倚风险。我们将数据汇总为标准化均数差（SMD）、加权均数差（WMD）或比值比（OR）及其 95%置信区间（95%CI）。
四项研究符合纳入标准（一项和三项研究分别为非随机和随机研究）。共有 405 例患者；205 例和 200 例患者分别接受了利多卡因和罗哌卡因治疗。在缝合时（WMD=-0.04，95%CI[-0.41，0.32]，P=0.82）、2 小时（SMD=-1.50，95%CI[-3.50，0.50]，P=0.14）和 24 小时（SMD=-0.40，95%CI[-1.15，0.34]，P=0.29）时，罗哌卡因组和利多卡因组的视觉模拟量表（VAS）疼痛评分无显著差异。在 24 小时时，罗哌卡因组有更多的患者（OR=4.34，95%CI[2.03，9.29]，P<0.001）VAS 疼痛评分≤3 分，疼痛较轻。两组在会阴修复后 24 小时内需要额外镇痛的患者比例无显著差异（OR=2.44，95%CI[0.09，68.21]，P=0.60）。罗哌卡因组产妇满意度更高（OR=7.13，95%CI[3.63，13.99]，P<0.001）。
在修复产后会阴创伤时，罗哌卡因的止痛效果相对较长，但安全性尚未得到充分研究。需要高质量和大样本的研究来证实这些发现。
