FPIN's Help Desk Answers

NSAIDs for Postpartum Perineal Pain

 

Am Fam Physician. 2018 Jun 1;97(11):online.

Clinical Question

Are nonsteroidal anti-inflammatory drugs (NSAIDs) effective in the treatment of postpartum perineal pain?

Evidence-Based Answer

Women with third- or fourth-degree perineal lacerations or who received an episiotomy can be given oral NSAIDs to reduce perineal pain in the first six hours postpartum. (Strength of Recommendation [SOR]: B, based on a meta-analysis of low-quality randomized controlled trials [RCTs].) Women who received an episiotomy may have a reduction in postpartum pain scores after receiving NSAID rectal suppositories and are less likely to request more analgesia. (SOR: B, based on a meta-analysis of heterogeneous RCTs and a small international RCT.)

Evidence Summary

A 2016 systematic review and meta-analysis (28 RCTs; N = 4,181) of nonbreastfeeding women with third- or fourth-degree perineal lacerations or episiotomy during vaginal delivery compared single-dose oral NSAIDs with placebo for the treatment of perineal pain.1 Fourteen different NSAIDs were evaluated; aspirin (500 to 650 mg), ibuprofen (300 to 800 mg), and meclofenamate (100 to 200 mg) were the most commonly used. Pain was assessed by patient report at four and six hours postpartum using various nonstandardized methods. Women receiving an NSAID were more likely to achieve at least a 50% reduction of pain at four hours after delivery (10 studies; N = 1,573; relative risk [RR] = 1.9; 95% confidence interval [CI], 1.6 to 2.2) and at six hours (17 studies; N = 2,079; RR = 1.9; 95% CI, 1.7 to 2.2) than women receiving placebo. Women who received an NSAID were also less likely to need additional analgesia at four hours after initial administration (four studies; N = 486; RR = 0.39; 95% CI, 0.26 to 0.58) and at six hours (10 studies; N = 1,012; RR = 0.32; 95% CI, 0.26 to 0.40). There were no statistical differences between NSAID type or dosage. At six hours, there was no difference in overall maternal adverse effects (13 studies; N = 1,388; RR = 1.4; 95% CI, 0.71 to 2.7). None of the studies assessed neonatal

Address correspondence to Vernon Wheeler, MD, at vernon.l.wheeler8.civ@mail.mil. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


Copyright © Family Physicians Inquiries Network. Used with permission.

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. Hedayati H, Parsons J, Crowther CA. Rectal analgesia for pain from perineal trauma following childbirth. Cochrane Database Syst Rev. 2003;(3):CD003931.

3. Wilasrusmee S, Chittacheron A, Jirasirtum S, Srisangchai P. Naproxen suppository for perineal pain after vaginal delivery. Int J Gynaecol Obstet. 2008;102(1):19–22.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.

 

 

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