| Lu et al.1515 Lu YY, Su ML, Gau ML, Lin KC, Au HK. The efficacy of cold-gel packing for relieving episiotomy pain - a quasi-randomised control trial. Contemp Nurse. 2015;50(1):26-35.
|
To assess the effect of a cold compress on episiotomy pain reduction/n=70. |
The study was performed with two groups containing 35 women in each. |
The IG underwent the application of ice pack in the perineal region with temperature ranging from 12 to 15ºC, lasting from 15 to 20 minutes and encouraged to perform ice pack as many times as possible in the first 4 hours postpartum. For the next three days, they should use at least 3 times a day. All IG and CG participants received routine care, consisting of nonsteroidal anti-inflammatory and hot-seat baths after 24 hours postpartum. |
For both groups, the pain was measured in 4 moments through BPI: 4h (immediately before the intervention), 12, 24 and 48h after birth. It was also assessed the interference of pain in the ADL, through a questionnaire developed for the research. |
BPI: significant reduction of pain 48 h after birth in the intervention group (p=0.002). DA questionnaire: significant reduction of pain interference on daily activities (p=0.001). |
| Oliveira et al.1616 Oliveira SM, Silva FM, Riesco ML, Latorre Mdo R, Nobre MR. Comparison of application times for ice packs used to relieve perineal pain after normal birth: a randomised clinical trial. J Clin Nurs. 2012;21(23-24)3382-91.
|
To compare the effect of applying ice pack for 10, 15 and 20 minutes in the perineal region in pain reduction/n=114. |
The research was done with three groups containing 38 patients each:
Group underwent 10 min intervention with ice packs;
Group underwent 15 min intervention with ice packs.
Control group underwent 20 min of ice. |
Single application of ice pack in the perineal region at -10ºC between 2 and 56 hours postpartum after vaginal birth, in women with pain ≥3 assessed by visual analog scale (VAS). |
The pain was measured in 4 moments through the VAS: before, immediately after, 20 minutes and 40 minutes after the intervention. |
The three groups presented significant pain reduction (p=0.001), with no statistical difference between them (p=0.066). Application of 10 minutes and 15 minutes of ice pack has the same benefits in reducing pain like that of 20 minutes. |
| Leventhal et al.1717 Leventhal LC, de Oliveira SM, Nobre MR, da Silva FM. Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial. J Midwifery Womens Health. 2011;56(2):141-6.
|
To assess the effectiveness of an ice pack applied for 20 minutes to relieve perineal pain after spontaneous vaginal birth/n=114. |
Participants included nulliparous women divided into 3 groups (n = 38 per group):
Experimental group underwent intervention with ice pack in the perineum;
Placebo group underwent intervention with water packs at room temperature;
Control group without intervention. |
The packages were applied in a single instance for 20 minutes in the perineal region, between 2 and 48 hours postpartum. The package consisted of a plastic bag 8cm wide by 16cm long, filled with 250mL of water. For the experimental group, the pack was placed in the freezer and removed as ice for the intervention. The ice and water packs were wrapped in 20×20 cm fine cotton fabric to avoid direct contact with the perineum. |
The data were collected daily by 4 evaluators between 11:00 and 15:00.
They were collected in the following sequence: interview, initial assessment of perineal pain, randomization, body temperature measurement, and perineal trauma length measured by the use of PeriruleTM. A numerical scale (zero to 10) was used for the assessment of pain. |
The use of an ice pack in the perineum is useful in the treatment of perineal pain after vaginal birth.
A comparison of mean pain at baseline and after 20 minutes showed significant pain reduction (p<0.001) in the 3 groups and the experimental group had a lower average pain score compared to the control group (p=0.032) |
| Morais et al.1818 Morais I, Lemos A, Katz L, Melo LF, Maciel MM, Amorim MM. Perineal pain management with cryotherapy after vaginal delivery: a randomized clinical trial. Rev Bras Ginecol Obst. 2016;38(7):325-32.
|
To assess the clinical effectiveness of cryotherapy to control pain and perineal edema after humanized vaginal birth / n=80 |
The volunteers were divided into 2 groups containing 40 volunteers in each:
Experimental group underwent cryotherapy;
Group without cryotherapy. |
The experimental group underwent 6 applications of ice pack crushed in the perineum region, for 20 minutes, reducing the temperature between 10 and 15 ° C, with 60 minutes between the applications. The group without cryotherapy received a water pack, which did not reduce the temperature at that level, respecting the same protocolof application of the experimental group. |
They were assessed: perineal pain and perineal edema with assessments performed immediately before and at the end of each application in each group to determine the immediate effects of the therapy and were reassessed at 24 hours postpartum to verify the late effects of cryotherapy. The combined pain assessment scale (CSAP) was used to assess pain level. |
There was no significant difference for perineal pain and edema scores between groups
with or without cryotherapy up to 24 hours after birth.
There was no difference between groups when repeated measures were analyzed in all assessments, considering the median pain scores (p=0.3) and perineal edema (p=0.9). Perineal cryotherapy did not influence the amount of analgesics used (p=0.07) and no adverse effects were recorded. |
| TENS |
| Kayman-Kose et al.1919 Kayman-Kose S, Arioz DT, Toktas H, Koken G, Kanat-Pektas M, Kose M, et al. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med. 2014;27(15):1572-5.
|
To assess the efficiency and reliability of TENS in the treatment of uterine pain and surgical incision after birth/n = 200. |
Participants were randomized into four groups:
Cesarean section group underwent intervention with TENS switched off;
Cesarean section group underwent intervention;
Vaginal birth group underwent intervention with TENS switched off;
Group of vaginal birth underwent intervention. |
All participants in the intervention groups received the application of TENS immediately after birth.
A frequency of 100Hz and intensity according to the patient's sensitivity were used for the intervention groups. No pulse width and time of application were reported.
For vaginal birth patients, the electrodes were positioned in the region of the lower abdomen corresponding to the fundus of the uterus. For those who underwent a cesarean section, the electrodes were positioned above and below the OW. |
Pain was assessed before and immediately after application through VAS and VNS. |
TENS is effective for uterine pain relief and operative wound. Pain reduction was significant for the groups that underwent TENS intervention.
For cesarean section: VAS and visual numerical scale (VNS) (p<0.001).
For vaginal birth: VAS (p=0.022) and VNS (p=0.005). |
| Pitangui et al.2020 Pitangui AC, Araújo RC, Bezerra MJ, Ribeiro CO, Nakano AM. Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial. Braz J Phys Ther. 2014;18(1):72-8.
|
To assess the effectiveness of low-intensity TENS and high-intensity TENS in episiotomy pain reduction / n = 33. |
The volunteers were randomized into three groups:
Group underwent intervention with TENS of 5Hz;
Group underwent intervention with TENS of 100Hz;
Placebo group on intervention with the device switched off. |
The intervention was performed for all groups between 6 and 24 hours postpartum with the electrodes in parallel, close to the episiotomy, following a pudendal and femoral nerve region. The intensity of the device was programmed according to the sensitivity of the patient, and the pulse width was 100µs. The intervention lasted 30 minutes. |
The pain was assessed through the NRS before the intervention, post-intervention, 30 minutes post-intervention and 60 minutes post-intervention. |
TENS of low and high intensity are effective in reducing perineal pain after episiotomy in the first 24 hours postpartum.
Significant reduction of pain between intervention and placebo groups immediately after resting (p=0.046) and sitting (0.008).
Significant reduction in pain between intervention and placebo groups at rest after 30 '(p=0.001) and after 60' (p=0.001). |
| Olsen et al.1313 Olsén MF, Elden H, Janson ED, Lilja H, Stener-Victorin E. A comparison of high- versus low-intensity, high-frequency transcutaneous electric nerve stimulation for painful postpartum uterine contractions. Acta Obstet Gynecol Scand. 2007;86(3):310-4.
|
To compare the effects of low and high-intensity high-frequency TENS in reducing abdominal pain caused by uterine contractions during breastfeeding/n = 21. |
Participants were randomized into two groups:Group underwent intervention with TENS using intensity less than 50mA performed in 13 volunteers;
Group underwent intervention with TENS using intensity of 10 to 15mA in eight volunteers. |
The intervention was performed in all groups 24 hours after vaginal birth without complications. The device has been programmed for a frequency of 70 to 100Hz and a pulse width of 0.2ms.
For the high-intensity group, the application was performed for 1 'and repeated if there was still a report of pain. For the low-intensity group, the time of therapy was not reported. |
The assessment of the pain was done through VAS before and after the application of TENS. |
High-intensity high-frequency TENS had a better outcome in reducing pain.
The high-intensity group presented a pain decline of 49 (CI = 66.5 - 33.2), and the low-intensity group had a decline of 21 (CI = 39.0 - 20.0) |
| Pitangui et al.2121 Pitangui AC, de Sousa L, Gomes FA, Ferreira CH, Nakano AM. High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: A randomized, controlled trial. J Obstet Gynaecol Res. 2012;38(7):980-7.
|
To assess the effectiveness of high-frequency TENS as a pain relief resource for postpartum women with episiotomy/ n=40. |
The volunteers were randomized into two groups with 20 participants each:
Group underwent intervention with TENS with high frequency;
The group without intervention. |
All were between 6 and 24 hours after a vaginal birth and had a mediolateral episiotomy. |
The pain was assessed through NRS before initiating the intervention, 60 minutes post-intervention and 120 minutes post-intervention.
MPQ and PRI were also used at baseline and 60 minutes after the current. |
The high-frequency TENS showed good results in the reduction of perineal pain in the postpartum period with episiotomy.
For MPQ, PRI and NRS assessment, a significant decrease (p <0.001) in the scores in the intervention group. |
| Lima et al. 2222 Lima, LE, Lima AS, Rocha CM, dos Santos GM, Bezerra AJ, Hazime AF, et al. High and low frequency transcutaneous electrical nerve stimulation in post-cesarean pain intensity. Fisioter Pesqui. 2014;21(3):243-8.
|
To assess the analgesic effect of TENS modulation in high (100Hz) and low (4Hz) frequency in post-cesarean section pain / n = 34. |
The patients were randomly assigned,
in three treatment groups:
G100: underwent TENS of 100Hz;
G4: underwent TENS of 4Hz;
GP: placebo group underwent TENS switched off. |
The participants were placed in dorsal decubitus position and remained in rest throughout the experiment so that there were no intercurrences that interfered
In the results. TENS was applied by medium of two channels with 4 siliconized rubber electrodes (5x3 cm) for individual use located 1 cm above and below the surgical incision, a pulse duration of 100 µs and intensity according to the sensorial threshold of each patient. The total TENS application time was 30 minutes and performed in a single session. |
Pain intensity was assessed by NRS before, immediately after and at 20-minute intervals (20, 40 and 60') after the electrostimulation period.
The initial assessment was performed respecting a minimum interval of 8 hours postpartum to avoid acute interferences of postanesthetic recovery. |
The results demonstrated a significant decrease of the NRS in the G100 only in relation to the pre-treatment condition (p<0.05). In the post-treatment intervals, the G100 presented a significant decrease in pain during all the intervals (p<0.05). G4 showed a significant decrease only in the 40 'and 60' intervals; and GP, only in the range of 60 '(p<0.05). TENS modulation at a high pulse rate had a greater analgesic effect than low-frequency TENS in post-cesarean section, postpartum women. |
| LASER |
| Santos et al.2424 Santos JdeO, Oliveira SM, Nobre MR, Aranha AC, Alvarenga MB. A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: A pilot study. Midwifery. 2012;28(5):e653-9.
|
To assess the efficiency of Low-intensity laser in the treatment of perineal pain after episiotomy (n=114). |
Participants were randomized into three groups with 38 participants each:
Group underwent intervention with LASER of 780nm of wavelength;
Group undergoing laser intervention with 660nm of wavelength;
Group underwent intervention with LASER switched off. |
All volunteers were in the range of 6 to 56 hours after vaginal birth with mediolateral episiotomy and had pain greater than 3 on VAS. The device used in the volunteers underwent the intervention was programmed at a dose of 8.8J/cm2, a spot of 0.04 cm2, power of 35mW, energy per point of 0.35 and applied punctually in the upper, the middle and lower point of the episiotomy for 10 seconds per application point. |
The pain was assessed before, immediately after 3 and 30 minutes after the application through VAS. |
|
| Santos et al.2323 Santos JdeO, de Oliveira SM, da Silva FM, Nobre MR, Osava RH, Riesco ML. Low-level laser therapy for pain relief after episiotomy: a double-blind randomised clinical trial. J Clin Nurs. 2012;21(23-24):3513-22.
|
To assess the effects of Low-intensity laser therapy for perineal pain and healing after episiotomy / n=52. |
Participants were randomized into two groups with 26 participants each:
LASER intervention group with 660nm wavelength;
Group underwent intervention with LASER switched off; |
All underwent vaginal birth with mediolateral episiotomy. The LASER application was performed in three moments: up to 2 hours after birth, between 20 and 24 hours after birth and between 40 and 48 hours postpartum. The device used in the volunteers underwent the intervention was programmed for a dose of 3.8J/cm2, a spot of 0.04mW, a spot of 0,04 cm2, the power of 15mW energy per point of 0.15 and applied punctually in the episiotomy for 10 seconds per application point. |
The pain assessment was done through VAS before and after each session. |
LASER did not reduce pain in the episiotomy.
Up to 2 h after birth: p=0.999Between 20 and 24 hours postpartum: p=0.758
Between 40 and 48 hours postpartum: p=0.662. |
| Auriculotherapy and Acupuncture |
| Kwan and Li1414 Kwan WS, Li WW. Effect of ear acupressure on acute postpartum perineal pain: a randomised controlled study. J Clin Nurs. 2014;23(7-8):1153-64.
|
To assess the effects of auricle pressure in reducing acute perineal pain in the first 48 hours postpartum / n=266. |
Participants were randomized into two groups:Intervention group with 126 women;Group without intervention with 130 women. |
Participants could take pain medication (500mg paracetamol/4 hours) if necessary.
In the two groups, the following stimulation points were chosen: "Apex of the auricle, Anus, external genital organs, Shenmen." The volunteers should press the points for 30", 1x / 4h.
In the intervention group, a seed adhesive was used while in the control group a seedless adhesive was used. |
The pain was assessed through VDPS and VAS: 12, 24 and 36 h after birth. Also, the average consumption of paracetamol was analyzed. |
Apparently, there are no positive results regarding the use of auricle pressure.No difference in pain was observed through AVA in the first two assessments (p=0.11, p=0.30, respectively). In the third assessment, there was pain difference between the groups (p=0.02).
In the analysis of pain through VDPS no difference was observed between the groups at any time (p=0.49, p= 0.27, p=0.06). As for paracetamol consumption (p=0.13, p=0.42, p=0.37). |
| Marra etal.2525 Marra C, Pozzi I, Ceppi L, Sicuri M, Veneziano F, Regalia AL. Wrist-ankle acupuncture as perineal pain relief after mediolateral episiotomy: a pilot study. J Altern Complement Med. 2011;17(3):239-41.
|
To assess the effectiveness of acupuncture in relieving perineal pain
after mediolateral episiotomy during birth/ n=42 |
The patients were divided into 2 equal groups with 21 volunteers each:
Intervention group underwent acupuncture treatment;
Group without intervention that was not treated with acupuncture. |
The intervention consisted of wrist-ankle acupuncture by inserting a needle in the right ankle. The needles were inserted within 2 hours after birth by an acupuncturist physician in 21 patients. The group without intervention was monitored during the hospitalization and oral analgesic request.
For additional pain relief, volunteers could request oral medication at any time during hospitalization. |
Acupuncture was considered ineffective when women treated with needles required one or more oral analgesics during hospitalization (data were extracted from the medical records by the acupuncturist). |
Wrist-ankle acupuncture is a simple and effective method to reduce pain referred by episiotomy after birth. Requests for oral analgesics were significantly more frequent in the control group (p<0.01). |
