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Risløkken J, Dalevoll Macedo M, Bø K, Ellström Engh M, Siafarikas F. The severity of second-degree perineal tears and perineal pain during three months postpartum: A prospective cohort study. Midwifery 2024; 131:103930. [PMID: 38320359 DOI: 10.1016/j.midw.2024.103930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Second-degree perineal tears are common and can vary widely in the extent of tissue trauma. Therefore, a better understanding of perineal pain based on tissue trauma severity in second-degree tears is needed. AIM The primary aim of this study was to assess differences in perineal pain according to the severity of perineal tears, with a focus on subcategories of second-degree tears, during the first three months postpartum. The secondary aim was to assess the use of pain medication and breastfeeding patterns according to the severity of the second-degree tears. METHODS In this observational cohort study, nulli- and multiparous women with singleton pregnancies were included during pregnancy. After birth, perineal tears were classified using the latest international classification system. In addition, second-degree tears were subcategorised according to percentage of damage to the perineum (<50 %=2A,>50 % but less than entire perineum=2B, affecting entire perineum, anal sphincter not involved=2C). Perineal pain, use of pain medication and breastfeeding patterns were assessed during a phone interview seven to ten days postpartum and through an electronic questionnaire three months postpartum. FINDINGS Out of 880 vaginal births, 852 participants completed the phone interview and 715 answered the electronic questionnaire. During the first three months postpartum, women with 2C-tears reported statistically significantly higher pain scores and more frequent use of pain medication compared to women with 2A-tears. There was no statistically significant difference between the number of participants not breastfeeding between second-degree tear subcategories. CONCLUSION Women with 2C-tears reported higher perineal pain scores and more use of pain medication compared to those with less severe tears during three months postpartum.
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Affiliation(s)
- Jeanette Risløkken
- University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway.
| | - Marthe Dalevoll Macedo
- University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Kari Bø
- Norwegian School of Sport Science, Department of Sports Medicine, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Marie Ellström Engh
- University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Franziska Siafarikas
- University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
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Matteo C, Roome K, Roberts N, Hill G, Hill H. A women-centred exploration of postpartum perineal pain when the perineum is diagnosed as intact: A French Gadamerian research study. Midwifery 2024; 129:103909. [PMID: 38134575 DOI: 10.1016/j.midw.2023.103909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Postpartum perineal pain is a frequent symptom (90%) with consequences on postnatal health regardless of whether the perineum remains intact. The impact of that pain on both short and long-term health has been studied and literature suggests midwives have a role to play in addressing this issue. However, the determinants of perineal pain when no lesions are identified are under researched and there is little understanding of women's views on this topic. AIM AND OBJECTIVES The aim of the study was to gain an understanding of postpartum perineal pain when the perineum is considered to be intact. The objectives were •To gain an understanding of postpartum pain and its consequences on health and well-being •To explore women's views and understanding of perineal pain postpartum •To gain an understanding of the determinants of postpartum perineal pain when no anatomic lesion is diagnosed. METHODS A Gadamerian hermeneutic approach was used to achieve a shared understanding of the issue. Participants were recruited from two maternity hospitals in the French area of Vaucluse. All women aged 18 to 45 years old, having given birth vaginally to a single live child and diagnosed with an intact perineum, were invited to participate in face-to-face interviews. Eleven participants were interviewed once, six of whom agreed to a second interview which took place over the telephone due to Covid lockdown. FINDINGS The findings identified three major themes 1. Can't honestly call it pain, 2. Reassurance in normality, 3. Managing the unexpected. The use of the word pain to describe perineal sensations in postpartum was questioned by the participants, who used inner resources to deal with these sensations. Fostering self-confidence, having the possibility to explain the sensations and qualifying them as normal were some approaches women usedto manage their postpartum perineal sensations in a positive manner.
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Affiliation(s)
- Caroline Matteo
- Department of Midwifery, Faculté des Sciences Médicales et Paramédicales, Aix-Marseille Universite Campus Nord, Ecole de Maïeutique, Chemin des Bourrely, 51 BVD Pierre Dramard, Marseille 13015, France.
| | - Karen Roome
- Department of Nursing and Community Health, Room A405, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland G4 0BA, United Kingdom
| | - Nicola Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Gordon Hill
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom
| | - Hazel Hill
- Department of Nursing & Community Health, School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom
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Augustino J, Moshi F, Joho A, Faustine J, Mageda K. Dataset comparing the effectiveness of perineal cold pack application over oral paracetamol 1000mg on postpartum perineal pain among women after spontaneous vaginal delivery in Dodoma region. Data Brief 2023; 51:109766. [PMID: 38053594 PMCID: PMC10694064 DOI: 10.1016/j.dib.2023.109766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
The data were collected from the Dodoma Regional Referral Hospital randomized clinical trial among postnatal women. The raw and analyzed data includes 228 postnatal women with the following information: age(years), marital status, education level, occupation, religion, residence, and income. It also includes the number of Antenatal Visits, perineal condition, birth weight of the newborn, and the magnitude of perineal pain at the start(time=zero), at 20,40 and 60 minutes. The participants were randomly allocated to either an intervention or control group. The intervention group received the cold pack, while the control group received the Paracetamol 1000mg start. Data were collected using a standardized questionnaire and then analyzed using Stata™ software (StataCorp LLC, College Station, TX, US) version 14 and IBM SPSS statistics 25. The outcome was pain intensity measured using a pain rating scale at the interval of 20 minutes up to 60 minutes. The intervention's effect was estimated using an analysis of variance(repeated measure ANOVA). Omega square test was used to establish the effect size. These data will help nurse midwives in health facilities analyze data and demonstrate the effectiveness of cold packs in relieving pain instead of oral paracetamol, hence increasing scaling up its utilization.
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Affiliation(s)
- Joyce Augustino
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania
| | - Fabiola Moshi
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania
| | - Angelina Joho
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania
| | - Joanes Faustine
- School of Nursing and Public Health, University of Dodoma, PO Box 395, Dodoma, Tanzania
| | - Kihulya Mageda
- President's Office, Regional Administrative Secretary and Local Government (PORALG)
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Dokuhaki S, Tayebi N, Keshavarz M, Akbarzadeh M. Investigation of the Relationship Between Religious Attitude and Postpartum Physical and Perineal Pain in Iran. J Relig Health 2023; 62:3313-3326. [PMID: 37460863 DOI: 10.1007/s10943-023-01869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 09/25/2023]
Abstract
Postpartum pain is one of the most important and common problems of postpartum mothers who resort to non-pharmacological strategies to relieve it due to the side effects of painkillers. This study was conducted to investigate the relationship between religiosity and postpartum physical and perineal pain. The sample size in this cross-sectional study was 101 women giving birth in educational and medical centers of Shiraz, Iran, that was selected by purposive-convenience sampling. Then, a questionnaire was completed for each of them including demographic characteristics, religious attitude, and visual scale of postpartum pain. Data were analyzed by SPSS software. The frequency of the majority of the research population was found at moderate religious attitudes 65.4% (72 individuals). There is a positive and Statistical inverse correlation between religious attitude and perineal pain. According to Fisher's test, in mothers with a high religious attitude, 9.7% had severe perineal pain, 41.9% had moderate pain, and 48.4% had mild pain (p = 0.001). Besides, in the case of physical pain, 3.2%, 35.5%, and 61.3% had severe, moderate, and mild pain, respectively. Regarding physical pains, with the increase in the level of mothers' religious attitude, physical pains also decreased, but the statistical relationship was not significant (p = 0.32). The results showed that the religiosity and spirituality of pregnant women have relieving effects on postpartum pain. Therefore, more attention to the spiritual dimension of human existence and planning to improve it using prayer therapy, dhikr, and meditation is suggested as a strategy to deal with the fear of pain and childbirth and reduce psychological and physical changes before and after childbirth. These findings apply to women with ectopic pregnancies in Iran.
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Affiliation(s)
- Sara Dokuhaki
- Department of Midwifery, Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimeh Tayebi
- Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran
| | - Maryam Keshavarz
- Department of the Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Akbarzadeh
- Department of Midwifery, School of Nursing and Midwifery, Maternal -Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Schneider J, Schöttle T, Randecker D, Schwaibold H. [Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) : A rare urological emergency]. Urologie 2023; 62:929-935. [PMID: 37142812 DOI: 10.1007/s00120-023-02082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) is a rare, semi-acute disease in young, healthy men. In addition to an anatomical predisposition, perineal microtrauma is stated as the main risk factor. MATERIALS AND METHODS A case report and the results of a literature search with descriptive-statistical processing of 57 peer-reviewed publications are presented. A therapy concept was drawn up for clinical practice. RESULTS Our patient was treated conservatively and was consistent with the 87 cases which have been published since 1976. IPTCC is a disease of young men (33.2 years, range 18-70), which is associated with pain and perineal swelling in 88%. Sonography and contrast-enhanced magnetic resonance imaging (MRI) proved to be the diagnostic modality of choice, demonstrating the thrombus and in 89% a connective tissue membrane inside the corpus cavernosum. Treatment included antithrombotic and analgesic (n = 54, 62.1%), surgical (n = 20, 23%), analgesic (n = 8, 9.2%), via injection (n = 2, 2.3%), as well as radiological interventional (n = 1, 1.1%) options. In 12 cases, erectile dysfunction, mostly temporary, which required phosphodiesterase (PDE)-5 therapy developed. Recurrence and prolonged courses were rare. CONCLUSION IPTCC is a rare disease in young men. Conservative therapy with antithrombotic and analgesic treatment has shown good chances of full recovery. If relapse occurs or the patient refuses antithrombotic treatment, operative/alternative therapy management should be considered.
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Affiliation(s)
- J Schneider
- Klinikum am Steinenberg Reutlingen, Steinenbergstr. 31, 72764, Reutlingen, Deutschland.
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Hemalatha Devi D, Bolanthakodi C, D’Cunha P, Bheema Bai M, Kumar Moharana A, TS D. Clinical equivalence of Trusynth fast ® and Vicryl rapide ® polyglactin 910 fast absorbing sutures on maternal morbidity experienced by women following episiotomy repair: a single-blind, randomized study. F1000Res 2023; 11:1179. [PMID: 37388624 PMCID: PMC10300501 DOI: 10.12688/f1000research.126555.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
Background: Episiotomy procedure enlarges the vaginal outlet to facilitate childbirth. Polyglactin 910 fast-absorbing sutures are widely used for the repair of episiotomy because of their rapid absorption and less inflammatory response. This study was designed for subjective assessment of perineal pain post-episiotomy repair, with Trusynth Fast ® and Vicryl Rapide ® polyglactin 910 fast-absorbing sutures. Method: This was a single-blind, randomized, prospective study conducted between January 7, 2021 and July 14, 2021 across two centers in India. Primiparous or multiparous women (18-40 years), who required episiotomy during vaginal delivery were included, and either Trusynth Fast ® (n=47) or Vicryl Rapide ® (n=49) suture was used for their episiotomy repair. The primary endpoint, perineal pain was assessed with visual analogue scale at all follow-up visits. The secondary endpoints, quantity of local anesthesia, number of sutures used, time to repair episiotomy, intraoperative suture handling, analgesics used, early and late wound complications, wound re-suturing, time to complete healing, presence of residual sutures, return to sexual activity, dyspareunia, and adverse events were also recorded. Results: The study showed no significant difference in perineal pain between the two groups at any visit. A statistically significant difference (p<0.05) in total score of episiotomy healing scale on day 2 (0.13±0.34 versus 0.35±0.56) and swelling on day 2 (8.51 versusversus 28.57%) was noted between Trusynth Fast ® and Vicryl Rapide ® group. Non-significant difference was observed between the groups regarding anesthesia, number of sutures, time to repair episiotomy, intraoperative suture handling, analgesics, puerperal fever, wound infection, dehiscence, hematoma, urinary incontinence, re-suturing, time to complete healing, return to sexual activity and dyspareunia. Conclusion: Trusynth Fast ® suture is clinically equivalent to Vicryl Rapide ® suture and can be used for episiotomy repair with minimal risk of perineal pain and wound complications. Clinical Trials Registry of India Registration: CTRI/2020/12/029925; Registered on December 18, 2020.
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Affiliation(s)
| | - Chethana Bolanthakodi
- Obstetrics & Gynecology, Father Muller Medical College, Mangalore, Karnataka, 575002, India
| | - Prema D’Cunha
- Obstetrics & Gynecology, Father Muller Medical College, Mangalore, Karnataka, 575002, India
| | - Mudiki Bheema Bai
- Obstetrics & Gynecology, Government Victoria Hospital, Visakhapatnam, Andhra Pradesh, 530001, India
| | - Ashok Kumar Moharana
- Clinical Affairs, Healthium Medtech Limited, Bangalore, Karnataka, 560058, India
| | - Deepak TS
- Clinical Affairs, Healthium Medtech Limited, Bangalore, Karnataka, 560058, India
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Rs S, D'lima SK, Shahanaz, Mateti UV, Sonkusare S. Assessment of pain and maternal complications after normal vaginal delivery. J OBSTET GYNAECOL 2021; 42:989-993. [PMID: 34907856 DOI: 10.1080/01443615.2021.1980514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Management of postpartum perineal pain is essential because untreated pain can interfere with the motherhood experience and might result in various complications. The study aimed to assess postpartum perineal and postpartum pain intensity, pharmacological management and maternal complications after normal vaginal delivery. A prospective observational study was conducted in Obstetrics and Gynaecology among 300 women who underwent normal vaginal delivery. The severity and intensity of the perineal pain in subjects were relatively high, i.e. severe on Day 1, moderate to mild pain on Day 2 and mild pain on Day 3. The overall postpartum pain was mild on all 3 d. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesic combination drugs were prescribed the most for pain management, which significantly impacted pain reduction. All participants involved in the study had a postpartum haemorrhage and was the most common complication. The study concludes that there was a significant reduction in the overall intensity of pain from Day 1 to Day 3.IMPACT STATEMENTWhat is already known on this subject? Vaginal delivery is a multidimensional process that causes inflammation of cervical tissue and tears in the birth canal, leading to pain perception. Previous studies reported increased pain intensity on the first day after childbirth and a gradual decrease as the days pass.What do the results of this study add? The well-accepted pain scales, such as faces rating scale (FRS) and verbal numeric scale (VNS) were appropriate for assessing the intensity of perineal pain. Self-developed and validated postpartum pain assessment questionnaire (PPAQ) was beneficial for the assessment of postpartum pain. NSAIDs and analgesics combination was effective in managing the pain.What are the implications of these findings for clinical practice and/future research? Accurate pain assessment is essential for humanising patient care since it helps make a correct plan for required intervention, and its evaluation can help provide appropriate medications and reduce complications. Self-developed and validated PPAQ is easy to use and can be used in clinical studies to assess postpartum pain.
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Affiliation(s)
- Srinidhi Rs
- Department of Pharmacy Practice, NITTE (Deemed to be University), NGSM Institute of Pharmaceutical Sciences, Mangaluru, India
| | - Sherwin Keith D'lima
- Department of Pharmacy Practice, NITTE (Deemed to be University), NGSM Institute of Pharmaceutical Sciences, Mangaluru, India
| | - Shahanaz
- Department of Pharmacy Practice, NITTE (Deemed to be University), NGSM Institute of Pharmaceutical Sciences, Mangaluru, India
| | - Uday Venkat Mateti
- Department of Pharmacy Practice, NITTE (Deemed to be University), NGSM Institute of Pharmaceutical Sciences, Mangaluru, India
| | - Shipra Sonkusare
- Department of Obstetrics and Gynaecology, NITTE (Deemed to be University), KS Hegde Medical Academy, Justice KS Hegde Charitable Hospital, Mangaluru, India
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Amarenco G. [ Perineal pain in Tintin adventures]. Prog Urol 2021; 31:414-421. [PMID: 33849743 DOI: 10.1016/j.purol.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
AIMS To analyze the determinants and severity of perineal pain in the adventures of Tintin and Snowy. MATERIAL AND METHODS All 23 adventures of Tintin and Snowy (Hergé, Moulinsart Ed.) were reviewed in order to determine the presence, causes and severity of perineal pain (PP) observed in the various heroes of this comic book. Several parameters were studied: the cause which could be either accidental or voluntary; the type of patient (good guys-bad guys); the hero concerned (Tintin, Captain Haddock, Thompson and Thomson, Snowy, Professor Calculus …); the duration of the pain (by the number of boxes where the subject was represented suffering from such pains); finally, the severity of these pains, by the number of stars or signs designating the region and stereotyping the importance of the pain. The Student and Chi2 tests were used to analyze these different qualitative and quantitative variables. RESULTS Five hundred and one traumas were found in the adventures of Tintin and Snowy, including 47 PP, 9.4% of cases compared to 299 head traumas (60% of cases). Six albums out of the 23 did not report any PP. PPs are usually traumatic either by a fall (68%) or by direct trauma (kick to the back 6%, spanking 4%) much more exceptionally by a bite (2 cases), a burn (2 cases), needles or arrows inserted in the bottom (5 cases) and a bullet wound (1 case). Tintin is the most concerned (19%) with Captain Haddock (23%), followed by Snowy (15%). The bad guys and the good guys don't share equally the perineal pain since the good guys are forgivably more exposed (79% vs. 21%). There is no correlation between head trauma and PP (r2=0.117). The severity index for PP is 5.21 with a mean duration of 3.01 vs. 6.88 for severity and 3.2 for duration for head trauma, a highly significant difference in the Student test (P=0.00259). The total number of traumas per album progressively decreases over the albums (r2=0.3111) with, for example, 38 for the first album (Tintin and the Soviets) and 4 for the last one (Tintin and the Picaros). This decrease in trauma is clearer for cephalic trauma (r2=0.1436) than for PP (r2=0.2189). CONCLUSION The frequency of traumatic PP in Tintin's adventures is important and is second only to head injuries. This frequency of PP traumas is undoubtedly linked to the hectic and adventurous life of Tintin and his acolytes exposed in all circumstances to all kinds of direct or indirect injuries. Future studies will have to specify the risk of after-effects and the psychological impact of PPs on the heroes concerned. LEVEL OF PROOF 4.
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Affiliation(s)
- G Amarenco
- Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of neuro-urology, Tenon hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Li SQ, Jiang L, Cui LG, Jia DL. Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain. World J Clin Cases 2021; 9:2153-2159. [PMID: 33850934 PMCID: PMC8017504 DOI: 10.12998/wjcc.v9.i9.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain. However, ganglion impar block combined with pulsed radiofrequency (GIB-PRF) for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.
AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIB-PRF in treating perineal pain.
METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016. Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure, and visual analogue scale (VAS) scores at 24 h before and after treatment and 1, 3, and 6 mo later were analyzed to evaluate clinical efficacy.
RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients, and no complications occurred. Compared with pretreatment scores, the VAS scores were significantly lower (P < 0.05) at the four time points after treatment. The VAS scores at 1 and 3 mo were slightly lower than those at 24 h (P > 0.05) and were significantly lower at 6 mo after treatment (P < 0.05). There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo (P > 0.05).
CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain. The 6-mo short-term clinical efficacy was favorable, but the long-term outcomes need future study.
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Affiliation(s)
- Shui-Qing Li
- Department of Pain Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Ling Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Dong-Lin Jia
- Department of Pain Medicine, Peking University Third Hospital, Beijing 100191, China
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Kim CS, Jang K, Leem JG, Shin JW, Kim DH, Choi SS. Factors associated with Successful Responses to Ganglion Impar Block: A Retrospective Study. Int J Med Sci 2021; 18:2957-2963. [PMID: 34220323 PMCID: PMC8241784 DOI: 10.7150/ijms.60962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/24/2021] [Indexed: 11/05/2022] Open
Abstract
Background: The ganglion impar (ganglion of Walther) block has been used to manage coccygeal and perineal (perianal and genital) pain due to both benign and malignant causes. However, the factors associated with successful responses to ganglion impar block are unknown. Therefore, in the present study, we aimed to identify the independent factors associated with successful responses to ganglion impar block in patients with chronic pain in coccygeal and perineal regions. Methods: From January 2008 to December 2017, we performed a retrospective review of 106 patients who underwent ganglion impar block. Patients were considered successful responders if they reported a decrease of more than 50% or 4 points on the 11-point (0 = no pain and 10 = worst possible pain) numerical rating scale 1 month after the procedure, while others were considered non-responders. Logistic regression analysis was performed to identify factors independently associated with successful responses at 1 month after the procedure. Results: Multivariable logistic regression analysis showed that cancer-related causes were significantly associated with successful responses at 1 month after ganglion impar block (odds ratio = 2.60, 95% confidence interval = 1.05 to 6.43, P = 0.038). Conclusion: Ganglion impar block may be more effective in cancer-related pain than pain due to benign causes.
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Affiliation(s)
- Chan-Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyounghwan Jang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Jottard K, Bruyninx L, Bonnet P, Mathieu N, De Wachter S. Pilot study: pudendal neuromodulation combined with pudendal nerve release in case of chronic perineal pain syndrome. The ENTRAMI technique: early results. Int Urogynecol J 2020; 32:2765-2770. [PMID: 33048179 DOI: 10.1007/s00192-020-04565-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Chronic perineal pain syndrome due to pudendal nerve impingement is difficult to diagnose and to treat. All the known treatment options leave room for improvement considering the outcome. Early neuromodulation of the pudendal nerve after its surgical release could improve outcomes. OBJECTIVES The aim of the study was to evaluate the potential beneficial effect of pudendal neuromodulation combined with release surgery using the ENTRAMI technique (endoscopic transgluteal minimally invasive technique). STUDY DESIGN This is a single-center prospective descriptive study. Between March 2019 and March 2020, 16 patients (2 males, 14 females) were included. Data were collected at baseline and 1 month after surgery. METHODS Patients eligible for inclusion had chronic perineal pain for at least 3 months in the area served by the pudendal nerve. We combined pudendal nerve release with neuromodulation. RESULTS At 1 month, the numeric pain rating scale (NPRS) dropped from 9.5 at baseline to 3.5 (p = 0.003). Seventy-six percent of patients showed a global impression of change (PGIC) of > 50% at 1 month, and optimal treatment response (PGIC ≥ 90%) was found in 41% of patients. LIMITATIONS The drawback of our study was that it was not randomized or blinded. The peripheral nerve evaluation lead (PNE) used could only be implanted for 1 month because of infection risk and is also prone to dislocations and technical failures. CONCLUSION Pudendal nerve liberation by the ENTRAMI technique combined with short-term pudendal neuromodulation seems feasible and promising in treating patients with chronic perineal pain. Clinical trial number: NCT03880786.
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Affiliation(s)
- Katleen Jottard
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020, Brussels, Belgium.
| | - Luc Bruyninx
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020, Brussels, Belgium
| | - Pierre Bonnet
- Department of Urology and Department of Anatomy, CHU Sart-Tilman, Liège, Belgium
| | - Nathalie Mathieu
- Department of Anesthesiology, Pain Clinic, Brugmann Hospital, Brussels, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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Cardaillac C, Ploteau S, Le Thuaut A, Dochez V, Winer N, Ducarme G. Ropivacaine 75 mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women - the ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trials. Trials 2020; 21:522. [PMID: 32532310 PMCID: PMC7291718 DOI: 10.1186/s13063-020-04423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 05/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother–infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy but have only focused on the immediate postpartum period (at 24 and 48 h after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. Methods/design The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial being conducted in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75 mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (midterm), defined by the Numeric Pain Rating Scale (NPRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (NPRS) and the impact of pain on daily behavior, on the quality of life (36-item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale), and on sexual health (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%. Discussion Ropivacaine is a promising candidate drug, inexpensive, and easy to administer, and it would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy. Trial registration ClinicalTrials.gov, NCT03084549. Registered on 14 April 2017.
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Affiliation(s)
- Claire Cardaillac
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, 44000, Nantes, France.,Federative Pelvic Pain Centre, Nantes University Hospital, 44000, Nantes, France
| | - Stéphane Ploteau
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, 44000, Nantes, France.,Federative Pelvic Pain Centre, Nantes University Hospital, 44000, Nantes, France
| | - Aurélie Le Thuaut
- Clinical Research Centre, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France
| | - Vincent Dochez
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, 44000, Nantes, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology and Reproductive Medicine, Nantes University Hospital, 44000, Nantes, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France.
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Türkmen H, Çetinkaya S, Apay E, Karamüftüoğlu D, Kılıç H. The Effect of Perineal Warm Application on Perineal Pain, Perineal Integrity, and Postpartum Comfort in the Second Stage of Labor: Randomized Clinical Trial. Complement Med Res 2020; 28:23-30. [PMID: 32460297 DOI: 10.1159/000507605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Protection of perineum and reduction of perineal pain is important in the second stage of labor. AIM The aim of this study was to determine the effect of perineal warm application on perineal pain, perineal integrity, and postnatal comfort in the second stage of labor. METHODS A single blind randomized and controlled experimental study was conducted with a total of 100 primiparous pregnant women in the warm application (n = 50) and control groups (n = 50). The warm application group was given a damp and warm application to the perineal region during the second stage of labor and only the standard midwifery care was given to the control group. Pregnant Introductory Form was used in the collection of data. Perineal pain level was measured prior to and after the intervention, after delivery, and 2 h from delivery by means of Visual Analogue Scale. In the postpartum period, the perineal condition was evaluated by the midwife with Questionnaire to Determine the Perineal Condition. Two hours from the delivery, Postpartum Comfort Questionnaire was used to determine the comfort level of the women. RESULTS It was found that there was a decrease in the pain levels of the warm application group compared to pre-intervention pain levels (p < 0.0001). When the warm application and control groups were compared, we found statistically significant differences between the pain levels immediately after the intervention (perineal pain: 8.54 ± 1.38 vs. 9.56 ± 0.57, p < 0.0001), after delivery (perineal pain: 2.20 ± 1.72 vs. 3.64 ± 2.07, p < 0.0001), and 2 h after delivery (perineal pain: 0.30 ± 0.78 vs. 0.68 ± 0.98, p = 0.028). In the study, the intactness of perineum was found to be significantly higher in the warm application group compared to the control group (p = 0.003). The suture need for perinea was significantly higher in the control group than in the warm application group (p = 0.016). In the study, the physical comfort level of the warm application group was found to be significantly higher than the control group (56.06 ± 4.61 vs. 54.30 ± 4.73, p = 0.012). CONCLUSIONS In the second stage of labor, it was found that the application of warmth decreases perineal pain, maintains the perineal integrity, and improves postpartum comfort.
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Affiliation(s)
- Hülya Türkmen
- Department of Midwifery, School of Health, Balıkesir University, Balıkesir, Turkey,
| | | | - Emine Apay
- Atatürk City Hospital, Delivery Room, Balıkesir, Turkey
| | | | - Hafize Kılıç
- Atatürk City Hospital, Delivery Room, Balıkesir, Turkey
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López-Lapeyrere C, Solís-Muñoz M, Hernández-López AB, Rodríguez-Barrientos R, González-Rubio R. Perineal repair of media-lateral episiotomies and 2nd degree tears by midwives: A randomised controlled trial comparing three suture techniques. Int J Nurs Stud 2020; 106:103553. [PMID: 32278106 DOI: 10.1016/j.ijnurstu.2020.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perineal trauma pain is associated with perineal repair and its subsequent healing. New evidence is required concerning perineal repair techniques that cause less pain and favour healing. OBJECTIVE To compare three perineal repair suturing techniques after episiotomy or second degree tearing during a normal birth with respect to reducing pain and improving the perineal healing process. DESIGN A randomised controlled trial. SETTING A large public university hospital in Madrid, Spain. PARTICIPANTS Full term pregnant women older than 18 years-of-age, who required perineal repair after episiotomy or second degree tearing and were attended for normal birth by midwives. METHODS One hundred and eighty-three women were randomly assigned to three groups: the Continuous Suture Group (n = 58), Interrupted Cutaneous Suture Group (n = 53), or the Interrupted Subcutaneous Suture Group (n = 57). The study participants and data collectors were blinded to group allocations. Principal outcome: perineal pain 10 days after birth. Other outcomes: short (2 and 48 h) and long term (3 and 6 months) perineal pain after birth; short term healing; suture time. RESULTS At 10 days postpartum, the presence of spontaneous pain, pain when walking or moving in bed, was almost nonexistent in the 3 suture groups. The median (P25-P75) perineal pain on palpation was similar in the 3 groups, with values of 2 (1-4) in the Continuous Suture Group, 3 (2-5) in the Interrupted Cutaneous Suture Group and 2 (1-4) in the Interrupted Subcutaneous Suture Group; also were similar the perineal pain on sitting: 1 (0-3) in the Continuous Suture Group, 1 (0-2) in the Interrupted Cutaneous Suture Group and 1 (0-3) in the Interrupted Subcutaneous Suture Group. There were no statistically significant differences between the groups. Pain measurements throughout the follow-up period only showed statistically significant differences in 2 out of 22 evaluations: pain when sitting 48 h after birth and spontaneous pain at 3 months. The mean times (standard deviation) to carry out suturing were 12.86 (4.9) minutes in the Continuous Suture Group, 13.54 (5.6) in the Interrupted Cutaneous Suture Group, and 15.59 (6.9) minutes in the Interrupted Subcutaneous Suture Group (p < 0.05). CONCLUSIONS The three suturing methods described for perineal repair after episiotomy or second degree tearing after normal birth are comparable with respect to short, medium and long term perineal pain and the healing process. Use of the continuous suturing technique involved less time than interrupted suture methods. Tweetable abstract: proper the suturing methods for perineal repair after episiotomy or second degree tearing prevent postpartum perineal pain.
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Affiliation(s)
- Carolina López-Lapeyrere
- Puerta de Hierro Majadahonda University Hospital. Calle Joaquín Rodrigo, 2, 28222 Majadahonda, Madrid, Spain; Nursing and Health Care Research Group, Puerta de Hierro-Segovia de Arana Health Research Institute. Calle Joaquín Rodrigo, 2, 28222 Majadahonda, Madrid, Spain.
| | - Montserrat Solís-Muñoz
- Puerta de Hierro Majadahonda University Hospital. Calle Joaquín Rodrigo, 2, 28222 Majadahonda, Madrid, Spain; Nursing and Health Care Research Group, Puerta de Hierro-Segovia de Arana Health Research Institute. Calle Joaquín Rodrigo, 2, 28222 Majadahonda, Madrid, Spain.
| | - Ana Belén Hernández-López
- Puerta de Hierro Majadahonda University Hospital. Calle Joaquín Rodrigo, 2, 28222 Majadahonda, Madrid, Spain; Nursing and Health Care Research Group, Puerta de Hierro-Segovia de Arana Health Research Institute. Calle Joaquín Rodrigo, 2, 28222 Majadahonda, Madrid, Spain.
| | - Ricardo Rodríguez-Barrientos
- Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud. Calle San Martín de Porres, 6, 28035 Madrid, Spain.
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- Puerta de Hierro Majadahonda University Hospital. Calle Joaquín Rodrigo, 2, 28222 Majadahonda, Madrid, Spain
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Şolt Kirca A, Kanza Gul D. 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; 301:473-81. [PMID: 31989291 DOI: 10.1007/s00404-020-05439-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Camacho JE, Usmani MF, Ho CY, Sansur CA, Ludwig SC. Perineal and Radicular Pain Caused by Contralateral Sacral Nerve Root Schwannoma: Case Report and Review of Literature. World Neurosurg 2019; 129:210-215. [PMID: 31203077 DOI: 10.1016/j.wneu.2019.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sacral schwannomas are very rare nerve sheath tumors. Patients usually present with a variety of nonspecific symptoms, which often lead to a delay in diagnosis. Although most schwannomas are benign, they present surgical challenges owing to their proximity to neurologic and other anatomic structures. CASE DESCRIPTION This 58-year-old female presented with a 2-month old history of left-sided perineal and radicular pain secondary to a right S2 sacral nerve root schwannoma. The sacral mass demonstrated homogenous enhancement with cystic changes in a T2-weighted magnetic resonance imaging sequence. The patient underwent S1-S3 laminectomy and tumor excision through a posterior surgical approach. Intraoperative monitoring was used to distinguish nonfunctional tissue during tumor resection. The patient had an unremarkable postoperative course. CONCLUSIONS Sacral schwannomas can present with a variety of nonspecific symptoms. They pose unique challenges given their location, size, and involvement of surrounding structures. Complete surgical resection is the main goal of sacral schwannoma treatment. A combined anterior-posterior surgical approach and a multidisciplinary surgical team are associated with improved outcomes.
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Affiliation(s)
- Jael E Camacho
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Farooq Usmani
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Cheng-Ying Ho
- Department of Pathology and Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Charles A Sansur
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Steven C Ludwig
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Huang LH, Lai YF, Chen GD, Lee MS, Ng SC. Effect of far-infrared radiation on perineal wound pain and sexual function in primiparous women undergoing an episiotomy. Taiwan J Obstet Gynecol 2019; 58:68-71. [PMID: 30638484 DOI: 10.1016/j.tjog.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the effect of far-infrared radiation on postpartum perineal pain and sexual function in primiparous women undergoing an episiotomy and 2nd degree perineal laceration. MATERIALS AND METHODS From May 2016 to May 2017, primiparous women with term pregnancies and vaginal deliveries with an episiotomy due to obstetric indications and 2nd degree perineal lacerations were invited to participate in this study. Women were randomly assigned into a far-infrared (FIR) group and a control group. Visual Analogue Scale (VAS) was used to evaluate the perineal pain immediately postpartum, and at 1 week and 6 weeks postpartum. Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) was used to evaluate sexual function at 6 weeks, 3 months and 6 months postpartum. RESULTS The data of the control group (n = 22) and FIR group (n = 18) were analyzed. Most of the women had minor perineal pain one week after delivery (1.1 ± 0.9 in control group vs 1.4 ± 1.5 in FIR group) and there was no significant difference between groups. The FIR group had a higher PISQ-12 total score at 3 months (35.4 ± 6.4 vs 34.7 ± 5.7) and 6 months (36.4 ± 5.6 vs 35.6 ± 5.7) postpartum compared with the control group but there was no statistically significant difference. CONCLUSION Our study did not show any additional benefit of postpartum far-infrared radiation on primiparous women undergoing an episiotomy and 2nd degree perineal lacerations.
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Manresa M, Pereda A, Bataller E, Terre-Rull C, Ismail KM, Webb SS. Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis. Int Urogynecol J 2019; 30:853-868. [PMID: 30770967 DOI: 10.1007/s00192-019-03894-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Perineal pain and dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy. METHODS Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception - December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or dyspareunia in women with SVB. RESULTS Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4-10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced dyspareunia whether perineal trauma existed or not. CONCLUSIONS Women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.
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Affiliation(s)
- Margarita Manresa
- Hospital General de Granollers, Carrer Francesc Ribas, s/n, 08402 Granollers, Barcelona, Spain.
| | - Ana Pereda
- Hospital General de Granollers, Carrer Francesc Ribas, s/n, 08402 Granollers, Barcelona, Spain
| | - Eduardo Bataller
- Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.,Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Terre-Rull
- Facultad de Medicina y Ciencias de la Salud: Escuela de Enfermería, Universitat de Barcelona, Barcelona, Spain
| | | | - Sara S Webb
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, UK
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Hulens MA, Dankaerts W, Rasschaert R, Bruyninckx F, Willaert ML, Vereecke C, Vansant G. Can patients with symptomatic Tarlov cysts be differentiated from patients with specific low back pain based on comprehensive history taking? Acta Neurochir (Wien) 2018; 160:839-844. [PMID: 29455410 DOI: 10.1007/s00701-018-3494-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/10/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Tarlov cysts (TCs) are expanded nerve root sheaths that occur near the dorsal root ganglion and result from increased intraspinal hydrostatic pressure. TCs most frequently affect the lumbosacral plexus and therefore may cause specific symptoms such as perineal pain and neurogenic bladder, bowel, and sphincter problems. It has been estimated that 1% of the population has symptomatic Tarlov cysts (STCs). However, STCs appear to be underdiagnosed, with the pain reported by patients commonly attributed to degenerative alterations seen on MRI. The aim of the present study is to investigate the utility of a comprehensive questionnaire for use by physicians in establishing the diagnosis of STCs. METHODS We compared questionnaire responses regarding patient history between 33 patients diagnosed with symptomatic TCs and 42 patients with chronic low back pain and sciatica due to disc problems or degenerative or inflammatory disorders. The diagnosis of STCs was confirmed using nerve conduction studies (NCS) and electromyography (EMG) of the sacral myotomes by an expert neurophysiologist. RESULTS The questionnaire responses revealed specific differences in perineal symptoms (perineal pain, dyspareunia, coccygodynia), bowel symptoms (constipation, diarrhea), bladder symptoms (hesitation, retention, frequency), and anal sphincter problems (anal pain, mild fecal incontinence). Additionally, sitting, walking, and straining aggravated pain more frequently in STC patients, and STC patients were more often forced to stop working and/or reduce their social activities. CONCLUSIONS Including the above-listed items in the patient history might facilitate differentiation of low back pain and sciatica due to STCs from that due to disc problems or degenerative or inflammatory disorders.
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López-Lapeyrere C, Serna-Gómez N, Hernández-López AB, Pérez-García MF, Tejeda-Esteban A, Solís-Muñoz M. The development and validation of a new postpartum sexual function and dyspareunia assessment tool: The Carol Scale. Midwifery 2018; 58:27-36. [PMID: 29277039 DOI: 10.1016/j.midw.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim is to develop a new tool to evaluate postpartum sexual function and dyspareunia which will facilitate better evaluation of perineal pain in woman after vaginal delivery. DESIGN The development and validation of the Carol Postpartum Sexual Function and Dyspareunia Assessment Scale. SETTING The Obstetrics and Gynecology Service of a University Hospital in central Spain. PARTICIPANTS 102 women after being attended for vaginal birth, and 5 midwife assessors. FINDINGS 81women reinitiated sexual activity (with vaginal intercourse) during the first three months postpartum. The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale (Carol Scale) was internally reliable with a Cronbach-α value of 0.79 (95%CI0.72-0.85). Cronbach-α coefficients for Carol Scale domains were: preparation for the sexual activity 0.69 (95%CI0.55-0.79), pain or discomfort on caressing the vulval area 0.86 (95%CI0.79-0.91), pain or discomfort related to vaginal intercourse 0.93 (95%CI0.90-0.95) and pain or discomfort after vaginal intercourse 0.86 (95%CI0.78-0.91). CONCLUSIONS The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale is valid and reliable for measuring sexual function and postpartum dyspareunia in women after being attended for vaginal birth. IMPLICATIONS FOR PRACTICE The Carol Scale could be used both clinically and in research to improve the quality of care for the mother after childbirth. The scale could help to identify problems in the reinitiation of postpartum sexual activity and, therefore, could contribute to widening the clinical information about these women and help in decision making.
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Abstract
Background: Millions of women worldwide undergo postpartum perineal repair under local infiltration. Inadequate postpartum pain management can negatively impact a mother's physical and psychological recovery. Aims: To study and compare the analgesic effect and maternal satisfaction with lignocaine versus ropivacaine infiltration for postpartum perineal pain relief. Materials and Methods: After clearance from the Institutional Ethics Committee, a double-blind prospective randomized study carried out on 100 parturients of aged 18–40 years who had spontaneous vaginal delivery, comparing 1% lignocaine and 0.75% ropivacaine infiltration for the repair of selective episiotomy or perineal injury. Time of the first analgesic (TFA) demand, maternal satisfaction at 24 h, and visual analog scale (VAS) pain score were studied. Statistical Analysis: Chi-square test and Student's t-test were used and P < 0.05 was considered as significant. Results: VAS pain score was significantly lower at 2 and 4 h in ropivacaine group versus lignocaine group (P < 0.0001). Significantly, longer TFA (10.2 ± 1.54 vs. 2.20 ± 0.44 h, P < 0.0001) and higher percentage of maternal satisfaction (86% vs. 44%) were observed in ropivacaine as compared to lignocaine group (P < 0.0001). Conclusions: Prolonged analgesia and higher rate of maternal satisfaction were found when ropivacaine infiltration was used for perineal repair as compared to lignocaine.
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Affiliation(s)
- Jyoti P Deshpande
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Girish Y Saundattikar
- Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Neels H, De Wachter S, Wyndaele JJ, Wyndaele M, Vermandel A. Does pelvic floor muscle contraction early after delivery cause perineal pain in postpartum women? Eur J Obstet Gynecol Reprod Biol 2016; 208:1-5. [PMID: 27875777 DOI: 10.1016/j.ejogrb.2016.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Pelvic floor muscle training is effective and necessary in the prevention and treatment of pelvic floor dysfunction during pregnancy and after childbirth. But because of the high prevalence of perineal pain observed in women after childbirth, many women and caregivers fear to start pelvic floor muscle training immediately after childbirth. However, it is unknown whether pelvic floor muscle contractions (PFMC) provoke perineal pain in women shortly after childbirth. Therefore, the main objective is to study whether PFMC performed immediately after childbirth is painful or not. STUDY DESIGN Observational longitudinal study. Perineal pain was assessed (1-6 days and 9 weeks postpartum) using a visual analogue scale (VAS 0-10) during PFMC and during several activities of daily living (ADL), during micturition and defecation. Descriptive statistics, Wilcoxon and McNemar tests were used. RESULTS A total of 233 women participated (148 primiparous and 85 multiparous). Immediately postpartum the prevalence and intensity of pain during ADL (73%; VAS 4.9 (±2.3)), micturition (47%; VAS 3.4 (±1.7)) and defecation (19%; VAS 3.6 (±2.2)) were significantly higher (all p<0.000) than during PFMC (8%; VAS 2.2 (±0.9)). At 9 weeks postpartum, 30% experienced perineal pain during sexual intercourse (VAS 4.6 +/- 2.3) and 18% during defecation (VAS 4.7 +/- 2.3), but none during PFMC. CONCLUSION Perineal pain is highly prevalent immediately after childbirth during ADL, micturition and defecation, but not during PFMC (only 8%). In case perineal pain occurs during PFMC, the intensity of pain is low (VAS 2). These results show that fear of perineal pain should not discourage women to start pelvic floor muscle training shortly after childbirth.
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Affiliation(s)
- Hedwig Neels
- Department Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Urology, Antwerp University Hospital, Edegem, Belgium.
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, University of Antwerp, Wilrijk, Belgium
| | | | - Michel Wyndaele
- Department of Urology, University of Antwerp, Wilrijk, Belgium
| | - Alexandra Vermandel
- Department Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Urology, Antwerp University Hospital, Edegem, Belgium
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Necesalova P, Karbanova J, Rusavy Z, Pastor Z, Jansova M, Kalis V. Mediolateral versus lateral episiotomy and their effect on postpartum coital activity and dyspareunia rate 3 and 6 months postpartum. Sex Reprod Healthc 2016; 8:25-30. [PMID: 27179374 DOI: 10.1016/j.srhc.2016.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/22/2015] [Accepted: 01/25/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Comparison of the effects of two episiotomy types on sexual activity, dyspareunia and overall satisfaction after childbirth. STUDY DESIGN A prospective follow-up study of a randomized comparative trial evaluating peripartum outcome of a vaginal delivery after mediolateral (MLE) or lateral (LE) episiotomy. MAIN OUTCOME MEASURES The participants completed questionnaires regarding sexual activity, dyspareunia, perineal pain, aesthetic appearance and overall satisfaction 3 (3M) and 6 months (6M) postpartum. RESULTS A total of 648 women were available for the analyses (306 MLE, 342 LE). The groups showed no difference regarding resumption and regularity of sex, timing of resumption, frequency and intensity of dyspareunia, perineal pain, aesthetic appearance or overall satisfaction 3M or 6M postpartum. 98.0% of women after MLE and 97.7% after LE resumed sexual intercourse within 6M after delivery (p = 0.74). In the same period 15.6% of women after MLE and 16.1% after LE suffered from considerable dyspareunia (p = 0.86). CONCLUSIONS Quality of sexual life and perception of perineal pain after MLE is equivalent to LE.
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Affiliation(s)
- Pavlina Necesalova
- Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Jaroslava Karbanova
- Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Zdenek Rusavy
- Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Zlatko Pastor
- National Institute of Mental Health, Klecany, Czech Republic
| | - Magdalena Jansova
- European Centre of Excellence NTIS - New Technologies for Information Society, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czech Republic
| | - Vladimir Kalis
- Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
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Akbarzade M, Ghaemmaghami M, Yazdanpanahi Z, Zare N, Mohagheghzadeh A, Azizi A. Comparison of the Effect of Dry Cupping Therapy and Acupressure at BL23 Point on Intensity of Postpartum Perineal Pain Based on the Short Form of McGill Pain Questionnaire. J Reprod Infertil 2016; 17:39-46. [PMID: 26962482 PMCID: PMC4769854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Perineal pain is a major morbidity in the first few days after delivery. This study aimed to investigate the effect of dry cupping therapy and acupressure at BL23 point on the intensity of postpartum perineal pain based on the short-form of McGill pain questionnaire (SMPQ). METHODS The present clinical trial was conducted on 150 subjects in 3 groups of 50 cases. After at least 4-8 hr of delivery, cupping therapy was performed for 15-20 min up to 3 times a week (once a day) and acupressure was performed for 15-20 min based on clockwise model. The short-form of McGill pain questionnaire was completed both before and after the intervention. The SPSS statistical software was used to analyze the data using repeated measures ANOVA. Besides, p<0.05 was considered statistically significant. RESULTS In the cupping therapy group, mean of the perineal pain intensity reduced from 37.5±6.8 before the intervention to 11.1±6.1, 6.9±4.7, and 3.8±3.6 immediately, 24 hr, and 2 weeks after the intervention, respectively. The results of study showed that the differences between the intervention and control groups were statistically significant (p<0.01). Mean difference of the perineal pain intensity in the acupressure group reached from 35.6±8.1 before the intervention to 10.4±5.5 two weeks after the intervention, so the variation between intervention and control groups was statistically significant. CONCLUSION The study findings showed that cupping therapy and acupressure reduced perineal pain. Therefore, they may be considered as effective treatments for reducing pain intensity of allowing delivery.
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Affiliation(s)
- Marzieh Akbarzade
- Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author: Marzieh Akbarzade, Department of Midwifery, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, P.O. Box: 71345-1359, Shiraz, Iran, E-mail:
| | - Mehrnoush Ghaemmaghami
- Departments of Midwifery, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Yazdanpanahi
- Maternal-Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najaf Zare
- Department of Biostatistics, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolali Mohagheghzadeh
- Department of Traditional Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Azizi
- Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Robbins JW, Lundy PA, Gard AP, Puccioni MJ. Perineal pain secondary to tethered cord syndrome: retrospective review of single institution experience. Childs Nerv Syst 2015; 31:2141-4. [PMID: 26280630 DOI: 10.1007/s00381-015-2879-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECT Tethered cord syndrome (TCS) encompasses a spectrum of neurological dysfunction related to excessive tension on the distal spinal cord resulting in anatomic deformation and metabolic disturbance. Symptoms typically manifest as back/leg pain, neurogenic bladder dysfunction, constipation, sphincter abnormalities, and scoliosis. To date, among the least well-described symptoms of TCS is pain or hypersensitivity in the perineal region. The authors reviewed their experience with spinal cord detethering to identify and further characterize those who present with perineal pain or hypersensitivity. METHODS Cases of spinal cord detethering at a single institution were retrospectively reviewed. Patients were initially identified by procedural codes. Cases were reviewed for presenting symptoms, specifically perineal pain or hypersensitivity. Magnetic resonance image (MRI) findings, clinical outcome, and length of follow-up were also noted. RESULTS Of the 491 patients identified, seven patients (1.4%) were identified as having preoperative perineal pain or hypersensitivity. All of these patients had complete resolution of perineal pain/hypersensitivity at the time of last follow-up. Furthermore, five (71%) of these patients experienced resolution of all initial symptoms. CONCLUSION Perineal pain or hypersensitivity can be an important symptom of spinal cord tethering. Spinal cord detethering may result in a good outcome and relief of perineal pain or hypersensitivity.
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26
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Battut A, Nizard J. [Impact of pelvic floor muscle training on prevention of perineal pain and dyspareunia in postpartum]. Prog Urol 2015; 26:237-44. [PMID: 26455776 DOI: 10.1016/j.purol.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Assessing the impact of perineal rehabilitation and massage on perineal pain and dyspareunia in the postpartum period, between 15days and 12months after delivery. METHODS We conducted an exhaustive review of the literature concerning pelvic floor rehabilitation in the postpartum between 1987 and May 2015, grading data by levels of evidence (LOE) according to the methodology recommendations for clinical guidelines. RESULTS Pelvic floor rehabilitation in the postpartum is not associated with a decreased prevalence of perineal pain and dyspareunia at 1year (LOE3). The practice of digital perineal massage during the third trimester of pregnancy is not associated with decreased prevalence at 3-month postpartum of perineal pain or dyspareunia (RR=0.64; 95% CI [0.39-1.08] and RR=0.96; 95% CI [0.84-1.08], respectively), except for women who have delivered vaginally (RR=0.45; 95% CI [0,24-0.87]) (LOE2). The practice of digital perineal massage or application of warm packs in the second stage of labor does not reduce perineal pain (RR=0.93; 95% CI [0.66-1.32]) or dyspareunia (RR=0.99; 95% CI [0.74-1.34]) at 3-month postpartum (LOE2). CONCLUSION There is no evidence of long-term benefit of perineal rehabilitation and perineal massage on perineal pain and dyspareunia in the year following childbirth. Further studies are needed to accurately assess the impact of therapeutic strategies proposed in France.
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Affiliation(s)
- A Battut
- Cabinet de sage-femme et rééducation périnéale, 68, rue des Prairies, 75020 Paris, France.
| | - J Nizard
- Service de gynécologie-obstétrique, groupe hospitalier de la Pitié-Salpêtrière, AP-HP, Sorbonne universités, université Paris 06, CNRS UMR 7222, inserm U1150, 75013 Paris, France
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Bharathi A, Reddy DBD, Kote GSS. A prospective randomized comparative study of vicryl rapide versus chromic catgut for episiotomy repair. J Clin Diagn Res 2013; 7:326-30. [PMID: 23543639 DOI: 10.7860/jcdr/2013/5185.2758] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/23/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES A significant number of women experience perineal trauma following vaginal deliveries and they require stitches. This may result in perineal pain, dyspareunia and faulty healing. The type of suture material which is used, will influence these factors. This study was conducted to compare the impact of two absorbable suture materials which were used for episiotomy repair, namely vicryl rapide and chromic catgut in relation to a short term maternal morbidity, in terms of the perineal pain and the wound healing. METHODS This was a prospective, randomized study which was conducted in the hospitals which were attached to JJMMC, Davangere. Four hundred women with episiotomies were randomly allocated to repair with either vicrylrapide or chromic catgut (200 each). The outcome measures which were assessed were perineal pain and wound healing at 24-48 hours, 3-5 days and 6 weeks postpartum. RESULTS The two groups were similar at the trial entry. As compared to the chromic catgut group, the vicryl rapide group was associated with less pain (32.5% vs 57%) and a less need for analgesia (15.5% vs 0.5) at 3-5 days. There was also a signifi- cant reduction in the wound indurations, uncomfortable stitches and wound dehiscence (4% vs 13.5%) and a better wound healing (p<0.05 significant) in the vicrylrapide group. No significant difference was noted in the perineal pain at 6 weeks postpartum. Wound infections (3.5%) and wound resuturing (2%) were seen in the chromic catgut group and they were absent in the vicrylrapide group. INTERPRETATION AND CONCLUSION So, this study concluded that vicrylrapide was the ideal suture material for episiotomy repair, which resulted in less perineal pain and a better wound healing.
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Affiliation(s)
- A Bharathi
- Assistant Professor, Department of Obstetrics & Gynaecology, ESIC MC and PGIMSR and MODEL Model Hospital , Rajajinagar, Bangalore-560010, India
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28
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Yamada K, Ishihara Y, Saito T. Relief of intractable perineal pain by coccygeal nerve block in anterior sacrococcygeal ligament after surgery for rectal cancer. J Anesth 1994; 8:52-54. [PMID: 28921200 DOI: 10.1007/bf02482755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/1992] [Accepted: 05/07/1993] [Indexed: 10/24/2022]
Abstract
Intractable perineal pain often appears in the anal region following abdominoperineal resection for the treatment of rectal cancer. In such cases, a subarachnoid block or transsacral block is generally used to control pain. However, these procedures sometimes cause complications such as dysuria or sensory paralysis of the pudendum. A new method of pain control is presented herein using absolute alcohol as a neurolytic agent to relieve localized perineal pain through a coccygeal nerve block in the anterior sacrococcygeal ligament. Five cadavers were necropsied to localize the coccygeal nerve. A loop consisting of S4, S5, and Co was found to exist in the space surrounded by the anterior surface of the coccygeal bone and the anterior sacrococcygeal ligament. Absolute alcohol was injected into this space. It is essential that the neurolytic agent remain localized in this space to avoid complications and to successfully block perineal pain. In all patients, we found that this method was extremely effective in blocking localized perineal pain without any complications.
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Affiliation(s)
- Koki Yamada
- Department of Anesthesiology, Nippon Medical School, Tama Nagayama Hospital, 1-7-1 Nagayama, 206, Tama City, Tokyo, Japan
| | - Yukinori Ishihara
- Department of Anesthesiology, Nippon Medical School, Tama Nagayama Hospital, 1-7-1 Nagayama, 206, Tama City, Tokyo, Japan
| | - Toshiyuki Saito
- Department of Anesthesiology, Nippon Medical School, Tama Nagayama Hospital, 1-7-1 Nagayama, 206, Tama City, Tokyo, Japan
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