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Luxey X, Lemoine A, Dewinter G, Joshi GP, Le Ray C, Raeder J, Van de Velde M, Bonnet MP. Acute pain management after vaginal delivery with perineal tears or episiotomy. Reg Anesth Pain Med 2024:rapm-2024-105478. [PMID: 38772634 DOI: 10.1136/rapm-2024-105478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/27/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND A vaginal delivery may be associated with acute postpartum pain, particularly after perineal trauma. However, pain management in this setting remains poorly explored. OBJECTIVE The aim of this systematic review was to evaluate the literature and to develop recommendations for pain management after a vaginal delivery with perineal trauma. EVIDENCE REVIEW MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and systematic reviews assessing pain after a vaginal delivery with perineal tears or episiotomy until March 2023. Cochrane Covidence quality assessment generic tool and the RoB Vis 2 tool were used to grade the quality of evidence. FINDINGS Overall, 79 studies (69 RCTs and 10 systematic reviews and meta-analyses) of good quality of evidence were included. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment. Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring. Local anesthetic infiltration, topical local anesthetic, ointment application, and pudendal nerve block are not recommended due to insufficient or lack of evidence. Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use. Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants. When a perineal suture is indicated, a continuous suture compared with an interrupted suture for the repair of episiotomy or second-degree perineal tears is recommended for the outcome of pain. For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain. CONCLUSIONS Postpartum pain management after a vaginal delivery with perineal trauma should include acetaminophen, NSAIDs, and ice or chemical cold packs. Epidural morphine should be reserved for severe perineal tears. A surgical repair technique should depend on perineal tear severity.
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Affiliation(s)
- Xavier Luxey
- Anesthesiology and Intensive Care Medicine, Hôpital Armand-Trousseau, DMU DREAM, AP-HP, Paris, Île-de-France, France
- Hôpital de la Timone service d'anesthésie réanimation 1, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Adrien Lemoine
- Anesthesia, Intensive Care and Perioperative Medicine, Tenon Hospital, DMU DREAM, AP-HP, Paris, France
| | - Geertrui Dewinter
- Biomedical Sciences Group, Department of Cardiovascular Sciences, Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Camille Le Ray
- Port Royal Maternity Unit, Cochin Hospital, Université Paris Cité, APHP, Paris, Île-de-France, France
- Centre for Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, INSERM, Paris, Île-de-France, France
| | - Johan Raeder
- Institute of Clinical Medicine, department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Marc Van de Velde
- Biomedical Sciences Group, department of cardiovascular sciences, Department of anesthesiolgy, University Hospitals Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Marie-Pierre Bonnet
- Centre for Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, INSERM, Paris, Île-de-France, France
- Department of Anesthesiology and Intensive Care Medicine, Armand Trousseau Hospital, DMU DREAM, GRC29, Sorbonne University, APHP, Paris, Île-de-France, France
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Hadizadeh-Talasaz F, Mardani F, Bahri N, Rakhshandeh H, Khajavian N, Taghieh M. Effect of Rosemary Cream on Episiotomy Wound Healing in Primiparous Women: A Randomized Clinical Trial. BMC Complement Med Ther 2022; 22:226. [PMID: 36028878 PMCID: PMC9413876 DOI: 10.1186/s12906-022-03675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
Background Delay in episiotomy wound healing can lead to infection. The application of natural antimicrobial agents isolated from herbal essences can be a good strategy to prevent the growth of bacteria and promote the wound healing process. Therefore, this study aimed to determine the effect of rosemary cream on episiotomy wound healing in primiparous women. Methods This triple-blind randomized clinical trial was conducted on 80 primiparous pregnant women who were referred to the maternity ward of Shahid Motahari Hospital in Marvdasht, Iran, from September 2019 to March 2020. These women were randomly assigned into two groups of intervention (rosemary cream) and control (placebo), using variable quadruple blocks. Both groups applied the prescribed cream (in a dose of 2 cm) uniformly on the sutured area to cover it with the cream. The cream was applied twice a day for 10 consecutive days postpartum, and the rate of wound healing was evaluated by the researcher in the first 12 h and at days 4 and 10 postpartum using the REEDA scale. The data were analyzed using SPSS software (Version 19) through the Chi-square test, Mann-Whitney U test, student’s t-test, and Fisher’s test. A p-value less than 0.05 (P < 0.05) was considered statistically significant. Results The mean ± SD REEDA score on the fourth day postpartum was obtained at 3.82 ± 0.93 and 4.25 ± 1.29 in the groups of rosemary cream and placebo, respectively (P = 0.17). However, the mean ± SD REEDA scores on the 10th day postpartum were determined at 0.75 ± 0.74 and 3.32 ± 2.54 in the rosemary cream and placebo groups, respectively, indicating a higher rate of episiotomy wound healing in the group of rosemary cream compared to placebo (P < 0.001). Conclusion Based on the obtained results, it seems that rosemary cream can be effective in healing episiotomy wounds in primiparous women. However, further studies are suggested to confirm the findings of this study. Trial registration This trial was registered in the Iranian Registry of Clinical Trials in 24/08/2019 with the IRCT ID: IRCT20190308042971N1. The first participant enrolled in this trial in September 2019. URL of registry: https://en.irct.ir/trial/40092.
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Bioactive Natural and Synthetic Polymers for Wound Repair. Macromol Res 2022. [DOI: 10.1007/s13233-022-0062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Overview of Chios Mastic Gum (Pistacia lentiscus) Effects on Human Health. Nutrients 2022; 14:nu14030590. [PMID: 35276949 PMCID: PMC8838553 DOI: 10.3390/nu14030590] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
Despite the remarkable development of the medical industry in the current era, herbal products with therapeutic potentials arise as attractive alternative treatments. Consequently, Chios mastiha, a natural, aromatic resin obtained from the trunk and brunches of the mastic tree, has recently gained increasing scientific interest due to its multiple beneficial actions. Chios mastiha is being exclusively produced on the southern part of Chios, a Greek island situated in the northern Aegean Sea, and its therapeutic properties have been known since Greek antiquity. There is now substantial evidence to suggest that mastiha demonstrates a plethora of favorable effects, mainly attributed to the anti-inflammatory and anti-oxidative properties of its components. The main use of mastiha nowadays, however, is for the production of natural chewing gum, although an approval by the European Medicines Agency for mild dyspeptic disorders and for inflammations of the skin has been given. The aim of this article is to summarize the most important data about the therapeutic actions of Chios mastiha and discuss future fields for its medical application.
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Smith CA, Hill E, Denejkina A, Thornton C, Dahlen HG. The effectiveness and safety of complementary health approaches to managing postpartum pain: A systematic review and meta-analysis. Integr Med Res 2021; 11:100758. [PMID: 34485073 PMCID: PMC8408636 DOI: 10.1016/j.imr.2021.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background Women experience pain from a number of causes during the postpartum period. Although pharmacological pain relief has shown to be effective, the efficacy of non-pharmacological methods of pain relief will be of interest to breastfeeding women. The aim of this systematic review was to examine the efficacy and safety of complementary approaches to manage postpartum pain. Methods A search of English language databases from their inception to 2020 was undertaken for randomised controlled trials and included primiparous and multiparous women who experienced postpartum pain up to two weeks post birth. The primary outcome was pain. The risk of bias was assessed using the Cochrane risk of bias tool. Results Thirty trials were included in the review, 25 trials (2,413 women) were included in the meta-analysis. Two trials of massage found a reduction in pain following caesarean birth within the first 24 h post birth (MD -2.64, 95–2.82 to -2.46, 184 women, I2 0%), and at seven days postpartum (MD -1.91, 95%CI -2.42 to -1.40, 2 trials, 120 women I2 37%). Two trials conducted with women receiving an episiotomy found reduction in perineal pain from herbal ointments within 24 h (MD -1.33, 95% CI -.96 to -0.70, 221 women) and at 14 days postpartum (MD -0.74, 95% CI -1.02 to -0.47, 4 trials). Few trials reported on safety, few trials were at an overall low risk of bias, and overall the quality of evidence was very low. Conclusion Further high quality trials are needed to determine the safety and effectiveness of herbal ointment and massage during the early postpartum period.
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Affiliation(s)
- Caroline A Smith
- Graduate Research School, Western Sydney University, Penrith, NSW, Australia.,THRI, Western Sydney University, Penrith, NSW, Australia
| | - Emma Hill
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Anna Denejkina
- Graduate Research School, Western Sydney University, Penrith, NSW, Australia.,THRI, Western Sydney University, Penrith, NSW, Australia.,Young and Resilient Research Centre, Western Sydney University, Penrith, NSW, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
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Kazemi F, Masoumi SZ, Shayan A, Refaei M, Moradkhani S, Firozian F. Effect of green tea ointment on perineal pain and wound healing after episiotomy: A randomized double-blind clinical trial. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2020.101258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The effect of acupressure applied to points LV4 and LI4 on perceived acute postpartum perineal pain after vaginal birth with episiotomy: a randomized controlled study. Arch Gynecol Obstet 2020; 301:473-481. [PMID: 31989291 DOI: 10.1007/s00404-020-05439-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Acupressure can be used for alleviating perineal pain sustained after a vaginal birth with episiotomy. To evaluate if a 10-min acupressure application relieved perineal pain after vaginal birth with episiotomy and if the analgesic effect was maintained for up to 120 min. METHODS A randomized controlled trial was conducted from January to May 2019 with 120 women. The participants were over 18 years old, had an episiotomy and experienced perineal pain ≥ 4, had not received anti-inflammatory medication or analgesics after childbirth, and were randomized to receive acupressure or ice-pack application on the perineum for 10 min or standard care. RESULTS Immediately post-intervention, the women in the experimental groups had a significantly higher decrease in perineal pain. Within 120 min, there was a significant difference in the pain levels between the three groups. Each method (acupressure, ice package and control group) is evaluated for 30 min (VAS 3), 60 min (VAS 4) and 120 min (VAS 5). Comparing these 3 methods the acupressure has significantly reduced pain after the application (VAS 3 3.20 ± 1.28 vs. 3.77 ± 1.27 vs. 4.82 ± 0.93, respectively, VAS 4 2.65 ± 1.33 vs. 3.5 ± 1.37 vs. 4.62 ± 0.97, respectively, VAS 5 2.02 ± 1.44 vs. 3.5 ± 1.37 vs. 4.57 ± 0.93, respectively, p < 0.05) CONCLUSION: Effective pain relief is achieved by applying acupressure for 10 min to the perineum and is maintained between 30, 60, and 120 min.
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Lei ZY, Chen JJ, Cao ZJ, Ao MZ, Yu LJ. Efficacy of Aeschynomene indica L. leaves for wound healing and isolation of active constituent. JOURNAL OF ETHNOPHARMACOLOGY 2019; 228:156-163. [PMID: 30107245 DOI: 10.1016/j.jep.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/05/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In traditional Chinese medicine, the aerial parts of Aeschynomene indica L. (AIL) have been used for wound healing, and to treat urinary tract infection, hepatitis, enteritis, dysentery, nyctalopia, conjunctivitis, urticaria, and furuncle. However, no scientific investigation has been conducted on its wound healing potential. AIM OF THE STUDY To investigate the effects of AIL extract on wound healing, isolate the active constituent and reveal the possible mechanism of enhancing wound healing. MATERIALS AND METHODS The circular excision wound healing model was used to evaluate in vivo wound-healing activity. Hematoxylin and eosin staining was applied to assess inflammatory cells infiltration, angiogenesis, fibroblast proliferation, collagen synthesis, collagen remodeling, and skin appendages generation. Sirius red-picric acid staining was employed for quantitative analysis of the ratio of collagen I/III. Immunohistochemical staining for CD68, CCR7 (CD197), CD163, TGF-β1 and α-SMA was performed to determine macrophages phenotypes transition (M1-to-M2) and prove the scar-improving effect of AIL on wound healing. RESULTS We successfully isolated the active constituent (Sub-Fr0.2) for wound healing from AIL extract, circular excision wound healing experiment and hematoxylin & eosin staining showed Sub-Fr0.2 has a significant promoting effect on wound healing. Results of sirius red-picric acid staining demonstrated a reduced ratio of collagen I/III in the Sub-Fr0.2 group as compared with the vehicle group. Immunohistochemical staining for CD68, CCR7 (CD197), and CD163 in the Sub-Fr0.2 group exhibited an elevated speed of macrophages transiting from M1 phenotype to M2 phenotype, when compared with the vehicle group. Besides, the expression of TGF-β1 and α-SMA were inhibited on wounds treated with the ointment containing Sub-Fr0.2. CONCLUSION Leaves of AIL and its active constituent (Sub-Fr0.2) effectively promoted wound healing and reduced scar formation, this efficacy might be exerted by accelerating macrophages phenotypes transition and inhibiting TGF-β1 and α-SMA expression.
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Affiliation(s)
- Zhi-Yong Lei
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Jing-Jing Chen
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Zhi-Jian Cao
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ming-Zhang Ao
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Long-Jiang Yu
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
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