Evaluation and Comparison the Efficacy of Bupivacaine Socked Spongostan and Bupivacaine Infiltration in Relieving Post Episiotomy Pain

Shaker Yassen, Najah; Ridha, Nadia

	Evaluation and Comparison the Efficacy of Bupivacaine Socked Spongostan and Bupivacaine Infiltration in Relieving Post Episiotomy Pain
IRAQI JOURNALOF COMMUNITY MEDICINE
Article 1, Volume 25, Issue 4, 2012, Pages 308-313
Authors
Najah Shaker Yassen; Nadia Ridha
Abstract
Back ground: The perineal pain resulting from episiotomy is a stressful factor in mothers, which interferes with their ability of nursing and doing their duties as a mother and may interfere with urination and defecation. Aim of the study: To evaluate and compare the efficacy of adding spongostan socked with bupivacaine at episiotomy bed, or 0.5% bupivacaine infiltrated alone with 1% of lidocaine( served as control) in relieving post episiotomy pain. Patients and method: A prospective comparative study was conducted at department of obstetrics and gynecology in Baghdad teaching hospital during the period of the first of January 2010 till the end of December 2010. During the period of the study a150 women had vaginal deliveries with mediolateral episiotomy and met the inclusion criteria after obtaining informed consent were recruited in the study and enrolled into 3 groups assigned as first group including 50 women receiving only 1% lidocaine locally infiltrated at episiotomy site served as control group , second group including 50 women receiving in addition to the local 1% lidocaine a 0.5 % bupivacaine infiltrated at episiotomy sit at the end of the reconstruction of their episiotomy , finally the third group including 50 women receiving 1% lidocaine infiltration at episiotomy site but prior to repair , an absorbable gelatin sponge (spongostan) soaked with 0.5% bupivacaine placed in the episiotomy bed without suturing matched with the length of episiotomy then continuo the suturing procedure . Results: In visual analog scale( VAS) At 0 hour, the pain score for the spongostan group(1.98±0.95) was significantly more than the score of Bupivacaine group (1.54±0.73) the P value <0.05 but significantly less than the lidocaine group (5.72±0.88) P value<0.05 ., Then the pain scores at 1, 1.5, 2, 6,and 24 hour for the spongostan group (0.66±0.62, 0.24±0.43, 0.18±0.38, 0.46±0.54, 0.86±0.35 respectively) were significantly lower than the bupivacaine group(1.04±0.57, 0.64±0.48, 0.56±0.50, 2.18±0.48, 3.16±0.79) P value<0.05 and the lidocaine group (3.54±0.81, 3.10±0.81, 3.54±0.61, 3.44±0.64, 2.42±0.53) the P value<0,05., Also the pain scores for the bupivacaine group at 1, 1.5, 2, 6, and 24 hour were significantly lower( 1.04±0.57, 0.64±0.48, 0.56±0.50, 2.18±0.48, 3.16±0.79) than the pain scores of lidocaine group(3.54±0.81, 3.10±0.81, 3.54±0.61, 3.44±0.64, 2.42±0.53) the P value<0.05. The analgesia requirement time for spongostan group (0.00) was significantly less than the bupivacaine (10.06±2.37) and the lidocaine groups (1.80±0.86) P value<0.05. Also The analgesia requirement time for the bupivacaine group (10.06±2.37) was significantly less than the lidocaine group (1.80±0.86).P value < 0.05, The analgesic doses required per 24 hour for the spongostan group (0.00) was significantly less than the Bupivacaine (1.00±0.00) and the lidocaine groups (1.98±.318) the P value<0.05 As well as the bupivacaine group(1.00±0.00) , showed a significantly less analgesic doses than the lidocaine group (1.98±.318) P value <0.05 Conclusions: 1. The addition of 0.5% bupivacaine at episiotomy sit had significantly less pain score and analgesic requirement than infiltration of 0.1% of lidocaine alone 2. But the adding of spongostan socked with bupivacaine at episiotomy bed is more superior in pain relieve than bupivacaine or lidocaine alone Key words: episiotomy, spongostan, bupivacaine
Keywords
episiotomy; spongostan; bupivacaine

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