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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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Envall N, Elgemark K, Kopp Kallner H. Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial. Am J Obstet Gynecol 2024:S0002-9378(24)00624-0. [PMID: 38796037 DOI: 10.1016/j.ajog.2024.05.038] [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: 01/26/2024] [Revised: 05/01/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Fear of pain associated with intrauterine device (IUD) placement has been identified as a significant barrier to the adoption of long-acting reversible contraception, contributing to lower utilization of the most effective reversible contraceptive methods. OBJECTIVE To assess whether instillation of intrauterine mepivacaine before IUD placement alleviates pain more effectively than a placebo. STUDY DESIGN We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving nulliparous women undergoing IUD placement. An intrauterine instillation of 10 mL of 20 mg/mL mepivacaine or 0.9 mg/mL sodium chloride was administrated through a hydrosonography catheter 2 minutes prior to IUD placement. Pain scores were assessed using a 100 mm visual analog scale (VAS) at prespecified time points. Primary outcome measured the difference in VAS pain scores between the intervention group and the placebo group during IUD placement. Secondary outcomes included VAS pain scores at instillation and 10 minutes after placement, tolerability of the placement pain, as well as acceptability of the analgesia method. RESULTS We enrolled 151 participants, with 76 assigned to the mepivacaine group and 75 to the placebo group. The mean VAS pain score during IUD placement showed a difference of 13.3 mm (95% confidence interval (CI) 5.75-20.87; P<.001): the mepivacaine group had a mean of 53.9 mm (standard deviation [SD] 22.8), while the placebo group had a mean of 67.2 mm (SD 22.4). After adjusting for each individual provider's impact, the difference in mean pain scores remained statistically significant (12.2 mm 95% CI 4.85-19.62; P<.001). A greater proportion of women in the intervention group reported tolerable pain during placement with 70/75 participants (93.3%) compared to 53/66 participants (80.3%) in the placebo group (P=.021). CONCLUSION The intrauterine instillation of mepivacaine results in statistically significant reduction in pain score among nulliparous women during IUD placement. Although the precise clinical impact of this pain reduction method remains uncertain, the observed reduction in pain score result in a higher proportion of women reporting tolerable pain. This finding and the high acceptance as a pain reduction method thereby suggests clinical relevance. Intrauterine instillation of mepivacaine is a possible strategy to increase IUD utilization, particularly among nulliparous women who are at high risk of unintended pregnancy.
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Affiliation(s)
- Niklas Envall
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Elgemark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
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Hashem AT, Mahmoud M, Aly Islam B, Ibrahem Eid M, Ahmed N, Mohamed Mamdouh A, Elkomy R, Fouad Elgamel A, Hamada AAA, Khalil EM, Ashour ASA, Said Ali A, Taher A, Hasan Hussein A, Elzahaby I, Hafez Mohamed Younes M, Salah E, Mojahed EM, Talaat B, ElHodiby M, Kamal Osman N, Adel Nour D, Khamis Y, Aly Hamed Elsallamy A, Ahmed Gehad M, Kotb MMM, Gad Allah SH. Comparative efficacy of lidocaine-prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial. Int J Gynaecol Obstet 2024; 165:634-643. [PMID: 35212402 DOI: 10.1002/ijgo.14157] [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: 07/25/2021] [Revised: 12/18/2021] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare efficacy of lidocaine-prilocaine (LP) cream versus misoprostol versus placebo before levonorgestrel-releasing intrauterine device (LNG-IUD) insertion. METHODS This randomized controlled trial (RCT) was conducted in a tertiary referral hospital from April 30, 2020 to March 1, 2021 on 210 parous women willing to receive LNG-IUD and delivered only by elective cesarean delivery (CD). Participants received 200 μg vaginal misoprostol or 5 ml of LP cream 5% or placebo 3 h before LNG-IUS insertion. Primary outcome was pain during LNG-IUD insertion, while secondary outcomes were pain 10 min post-procedure, ease of insertion, patient satisfaction, insertion time, and drug side effects. RESULTS Pain during LNG-IUS insertion was reduced in LP group and misoprostol group compared to placebo group (2.1 ± 1.0 vs 3.7 ± 1.6; p <0.001) and (2.3 ± 1.3 vs 3.7 ± 1.6; p <0.001), respectively. Ease of procedure and patient satisfaction were significantly higher in LP and misoprostol groups than placebo (P <0.001). Need for additional analgesia was significantly higher in placebo group than in the other two groups (P = 0.009). Adverse events were not significantly different between the three groups except vomiting and abdominal cramps, which were higher with misoprostol. CONCLUSION LP cream and 200 μg of vaginal misoprostol administration before LNG-IUD insertion in women delivered only by elective CD effectively reduced pain during insertion and 10 min post-procedure with easier insertions, high patient satisfaction, and tolerable side effects. Pain reduction with LP cream was clinically significant.
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Affiliation(s)
- Ahmed T Hashem
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Mahmoud
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Bassem Aly Islam
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Ibrahem Eid
- Department of Obstetrics & Gynecology, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - Nancy Ahmed
- Department of Obstetrics &Gynecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Ahmed Mohamed Mamdouh
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha Elkomy
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Fouad Elgamel
- Department of Obstetrics &Gynecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - A A Ali Hamada
- Department of Obstetrics &Gynecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Eman M Khalil
- Department of Obstetrics &Gynecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Ahmed S A Ashour
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ayman Taher
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Hasan Hussein
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Elzahaby
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Emad Salah
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman M Mojahed
- Department of Obstetrics &Gynecology, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Bassem Talaat
- Department of Obstetrics &Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed ElHodiby
- Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
| | - Nada Kamal Osman
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Adel Nour
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Khamis
- Department of Obstetrics &Gynecology, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - Ayman Aly Hamed Elsallamy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
| | - Mahmoud Ahmed Gehad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | | | - Sherine H Gad Allah
- Department of Obstetrics &Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Zhu Y, Niu S, Zhang Y, Zhang H, Chang J, Ye L. Effect of lidocaine spray on reliving non-coring needle puncture-related pain in patients with totally implantable venous access port: a randomized controlled trial. Support Care Cancer 2023; 31:452. [PMID: 37421451 PMCID: PMC10329572 DOI: 10.1007/s00520-023-07910-4] [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: 03/22/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Patients with the placement of a totally implantable venous access port (TIVAP) commonly suffer from pain caused by inserting a non-coring needle. At present, lidocaine cream and cold spray are extensively used for pain management, but they are complex to manage in busy medical environments and developing countries. The lidocaine spray combines the analgesic effect of lidocaine cream and the rapid onset of cold spray, which can effectively alleviate the pain related to non-coring needle puncture in patients with TIVAP. This randomized-controlled trial aimed to explore the effectiveness, acceptability, and safety of lidocaine spray in relieving the pain of non-coring needle puncture in patients with TIVAP. METHODS A total of 84 patients who were hospitalized in the oncology department of a Grade III Level-A hospital in Shanghai from January 2023 to March 2023 and were implanted with TIVAP and required non-coring needle puncture were selected as the study subjects. The recruited patients were randomly assigned to the intervention group and the control group (n=42). Before routine maintenance, the intervention group received lidocaine spray 5 min before disinfection, while the control group received water spray 5 min before disinfection. The main clinical outcome was pain, and the degree of puncture pain in both groups was evaluated using the visual analogue scale. RESULTS There were no significant differences between the two groups in age, gender, educational level, body mass index, port implantation time, and disease diagnosis (P>0.05). The pain score in the intervention and control groups was 15.12±6.61mm and 36.50±18.79mm, respectively (P<0.001). There were 2 (4.8%) patients with moderate pain in the intervention group and 18 (42.9%) patients with moderate pain in the control group (P<0.001). In the control group, 3 (7.1%) patients reported severe pain. The median comfortability score for the two groups of patients was 10, but there was a difference between the two groups (P<0.05) because the intervention group tilted to the right. The successful puncture rate of the first time puncture had no difference between the two groups, both being 100%. Moreover, 33 patients (78.6%) in the intervention group and 12 patients (28.6%) in the control group reported that they would choose the same spray for intervention in the future (P<0.001). During the 1 week of follow-up, 1 patient in the intervention group developed skin itching (P>0.05). CONCLUSIONS The local use of lidocaine spray in patients with TIVAP is effective, acceptable, and safe to alleviate the pain caused by non-coring needle puncture. TRIAL REGISTRATION Chinese Clinical Trial Registry (registration number: ChiCTR2300072976).
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Affiliation(s)
- Ying Zhu
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Sihua Niu
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Yejun Zhang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Huiyan Zhang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Jian Chang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China
| | - Liqin Ye
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, No. 650, Xinsongjiang Road, Songjiang District, Shanghai, China.
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FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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