Medicine by the Numbers

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Oral NSAIDs for Perineal Pain in the Early Postpartum Period

 

Am Fam Physician. 2017 May 1;95(9):online.

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ORAL NSAIDS FOR PERINEAL PAIN IN THE EARLY POSTPARTUM PERIOD

BenefitsHarms

1 in 3 had adequate pain relief at 4 and 6 hours

No significant adverse effects

1 in 5 required no further analgesia after 4 hours

1 in 3 required no further analgesia after 6 hours


NSAIDs = nonsteroidal anti-inflammatory drugs.

ORAL NSAIDS FOR PERINEAL PAIN IN THE EARLY POSTPARTUM PERIOD

BenefitsHarms

1 in 3 had adequate pain relief at 4 and 6 hours

No significant adverse effects

1 in 5 required no further analgesia after 4 hours

1 in 3 required no further analgesia after 6 hours


NSAIDs = nonsteroidal anti-inflammatory drugs.

Details for This Review

Study Population: Postpartum women who had perineal pain after vaginal delivery and were not breastfeeding

Efficacy End Points: Adequate pain relief defined by at least 50% reduction in pain at four and six hours; no additional need for analgesics

Harm End Points: Adverse effects at four and six hours, including nausea, vomiting, sedation, constipation, diarrhea, drowsiness, sleepiness, and psychological impacts

Narrative: Perineal pain is common after vaginal childbirth. Physicians delivering newborns should be comfortable treating this pain. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in treating postpartum pain and have been studied extensively.1 These medications are not completely benign because they have been associated with adverse cardiovascular, gastrointestinal, and renal side effects.2 With these potential adverse effects in mind, this review evaluated oral NSAIDs for the treatment of perineal pain in the early postpartum period in women who have trauma to the perineum from first- to fourth-degree lacerations.

This review included 28 studies that examined 13 NSAIDs and included 4,181 postpartum women. A single-dose NSAID was given to 2,642 women in the early post-partum period, whereas 1,539 received placebo. More women who received an NSAID had adequate pain relief in the first four

Author disclosure: No relevant financial affiliations.

REFERENCES

1. Wuytack F, Smith V, Cleary BJ. Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Database Syst Rev. 2016;(7):CD011352.

2. Jordan J. Topical NSAIDs for acute musculoskeletal pain in adults. Am Fam Physician. 2016;94(1):online. http://www.aafp.org/afp/2016/0701/od1.html.

This series is coordinated by Dean A. Seehusen, MD, MPH, AFP Contributing Editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at http://www.aafp.org/afp/mbtn.

 

 

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