1
|
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.
Collapse
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
| |
Collapse
|
2
|
Tekin YE, Iyigun E, Karakoc O. The Effects of Two Different Cold Application Times on Edema, Ecchymosis, and Pain After Rhinoplasty: A Randomized Clinical Trial. J Perianesth Nurs 2024; 39:455-460. [PMID: 38180392 DOI: 10.1016/j.jopan.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/04/2023] [Accepted: 10/01/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study was performed to determine the effects of different cold application times to the periorbital area after rhinoplasty on edema, ecchymosis, and pain. DESIGN A randomized clinical study. METHODS Patients were divided into two groups, and cold application was applied to one group for 4 hours and to the other for 48 hours. The cold application was applied with ice packs for 20 minutes every hour to the periorbital region in both groups. Data were collected with the Patient Information Form, Scoring Diagram for Edema, the Scoring Diagram for Ecchymosis, and the Visual Analogue Scale for Pain. FINDINGS Periorbital edema, eyelid ecchymosis, and pain were not significantly different between the two groups. The mean edema score of the 48-hour group was 0.87 ± 0.93, while the mean edema score of the 4-hour group was 0.70 ± 0.87 (P = .48) on the 2nd day. The mean ecchymosis score was found as 2.03 ± 1.12 in the 48-hour group and 2.10 ± 1.09 in the 4-hour group (P = .817). The mean pain score was 12.50 ± 17.40 in the 48-hour group and 13.00 ± 16.00 in the 4-hour group (P = .98). CONCLUSIONS The effects of 48-hour and 4-hour cold applications are similar. Cold application for 4 hours may be recommended to patients who undergo rhinoplasty, as it is more practical and easier to apply than the 48-hour practice.
Collapse
Affiliation(s)
- Yasemin Eda Tekin
- Nursing Department, Faculty of Health Sciences, Mudanya University, Bursa, Turkey.
| | - Emine Iyigun
- Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Omer Karakoc
- Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
| |
Collapse
|
3
|
Chen CT, Tung HH, Chen YC, Wang JL, Tsai SH, Huang YT, Hsu TF. Cold application for pain and anxiety reduction following chest tube removal: A systematic review and meta-analysis. J Clin Nurs 2023; 32:574-583. [PMID: 35388557 DOI: 10.1111/jocn.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 01/17/2023]
Abstract
AIM AND OBJECTIVES To conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after chest tube removal (CTR). BACKGROUND The act of removing the chest tube often causes pain among cardiothoracic surgery patients. Most guidelines regarding CTR do not mention pain management. The effects of cold application on reducing pain and anxiety after CTR are inconsistent. DESIGN Systematic review and meta-analysis. METHODS We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomised controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration's tool was used to assess the risk of bias, Review Manager 5.4 was used to conduct the meta-analysis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used for assessing certainty of evidence (CoE). RESULTS Ten RCTs with 683 participants were included in the meta-analysis. The use of cold application could effectively reduce pain and anxiety after CTR. The subgroup showed that a skin temperature drops to 13°C of cold application was significantly more effective for the immediate reduction in pain intensity after CTR compared with control group. The GRADE methodology demonstrated that CoE was very low level. CONCLUSION Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. Skin temperature drops to 13°C or lasts 20 min of cold application were more effective for immediate reduction of pain intensity following CTR. RELEVANCE TO CLINICAL PRACTICE In addition to pharmacological strategy, cold application could be used as evidence for reducing pain intensity and anxiety level after CTR.
Collapse
Affiliation(s)
- Chia-Te Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Heng-Hsin Tung
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Han Tsai
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Teh-Fu Hsu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|