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Restaino S, Degano M, Rizzante E, Battello G, Paparcura F, Biasioli A, Arcieri M, Filip G, Vetrugno L, Dogareschi T, Bove T, Petrillo M, Capobianco G, Vizzielli G, Driul L. Lidocaine spray vs mepivacaine local infiltration for suturing 1st/2nd grade perineal lacerations: a randomised controlled non-inferiority trial. BMC Pregnancy Childbirth 2024; 24:439. [PMID: 38914976 PMCID: PMC11194923 DOI: 10.1186/s12884-024-06640-7] [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: 01/09/2024] [Accepted: 06/13/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Perineal lacerations are a very common complication of post-partum. Usually, the repair of 1st and 2nd-grade lacerations is performed after the administration of local anesthesia. Despite the great relevance of the problem, there are only a few studies about the best choice of local anesthetic to use during suturing. We performed a randomised controlled trial to evaluate the efficacy and safety of the use of a local anesthetic spray during the suturing of perineal lacerations in the post-partum. METHODS We compared the spray with the standard technique, which involves the infiltration of lacerated tissues, using the NRS scale. 136 eligible women who had given birth at University Hospital of Udine were enrolled and randomly assigned to receive nebulization of Lidocaine hydrochloride 10% spray (experimental group) or subcutaneous/submucosal infiltration of mepivacaine hydrochloride (control group) during suturing of perineal laceration. RESULTS The lacerations included 84 1st-grade perineal traumas (61.7%) and 52 2nd-grade perineal traumas (38.2%). All the procedures were successfully completed without severe complications or serious adverse reactions. There were no statistically significant differences between the two groups in terms of blood losses or total procedure time. Moreover, there were no statistically significant differences in terms of NRS to none of the intervals considered. Regarding the application of the spray in the B group, in 36 cases (52.9%) it was necessary to improve the number of puffs previously supposed to be sufficient (5 puffs). Just in 3 cases, an additional injection was necessary (4.4%). CONCLUSIONS Our study demonstrates that lidocaine spray alone can be used as a first line of local anesthetic during the closure of I-II-grade perineal lacerations, as it has comparable efficacy to mepivacaine infiltration. TRIAL REGISTRATION The trial was recorded on https://clinicaltrials.gov . Identification number: NCT05201313. First registration date: 21/01/2022. Unique Protocol ID: 0042698/P/GEN/ARCS.
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Affiliation(s)
- Stefano Restaino
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
- PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, Sassari, Sardinia, Italy
| | - Matilde Degano
- Department of Medicine (DMED), University of Udine, Via Palladio, 8, Udine, UD, 33100, Italy.
| | - Elisa Rizzante
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
| | - Ginevra Battello
- Department of Medicine (DMED), University of Udine, Via Palladio, 8, Udine, UD, 33100, Italy
| | - Federico Paparcura
- Department of Medicine (DMED), University of Udine, Via Palladio, 8, Udine, UD, 33100, Italy
| | - Anna Biasioli
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
| | - Martina Arcieri
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
| | - Gabriele Filip
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Via Dei Vestini, Chieti, CH, 66100, Italy
| | - Teresa Dogareschi
- Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
| | - Tiziana Bove
- Department of Medicine (DMED), University of Udine, Via Palladio, 8, Udine, UD, 33100, Italy
- Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Piazza Università, 21, Sassari, 07100, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Piazza Università, 21, Sassari, 07100, Italy
| | - Giuseppe Vizzielli
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy.
- Department of Medicine (DMED), University of Udine, Via Palladio, 8, Udine, UD, 33100, Italy.
| | - Lorenza Driul
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, Udine, UD, 33100, Italy
- Department of Medicine (DMED), University of Udine, Via Palladio, 8, Udine, UD, 33100, Italy
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Factors Influencing on Pain in Patients Undergoing Pipelle Endometrial Biopsy for Abnormal Uterine Bleeding: Why a Personalized Approach Should Be Applied? J Pers Med 2022; 12:jpm12030431. [PMID: 35330431 PMCID: PMC8950507 DOI: 10.3390/jpm12030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Objectives. Abnormal uterine bleeding (AUB) is a common complaint of women in different age groups, and endometrial biopsy is widely used to investigate the underlying causes. The aim of this observational study was to assess factors influencing pain in patients undergoing endometrial biopsy for AUB. Methods. Pain intensity before, during, and after Pipelle sampling was evaluated using the numerical rating scale (NRS), where “0” represents no pain at all, “10”—the worst pain ever possible. Pain rating was categorized as 1−6—mild to moderate, 7 and above as severe pain. Results. The study included 160 women who underwent Pipelle biopsy. The median age in the cohort was 42 (34−48) years, 18.1% of women were postmenopausal, 56.3% were either overweight or obese, 30% were nulliparous and 80% reported urban residency. The median pain score during the procedure was 2 (0−4). Pain scores of 5 (4−7) were reported with the junior gynecologist and 2 (0−4) in the senior gynecologist (p < 0.0001). Conclusion. The pain was found to have a strong association with the type of provider performing the endometrial sampling procedure. This fact suggests the need for a personalized approach and that psychological or informational interventions should be scheduled before the procedure to decrease pain and increase satisfaction.
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