Wound pain may be reduced by prior infiltration of the episiotomy site after delivery under epidural analgesia

Abstract

Local infiltration is seldom used during episiotomy repairs in patients who have been delivered under an effective epidural block and increased post-episiotomy pain has been found in association with epidural analgesia. The hypothesis that this leads to tight wound closure and thereby causes increased perineal pain was examined in a double-blind randomized trial in patients who had normal deliveries and mediolateral episiotomies. Mean pain scores on the day after delivery were significantly reduced from 4.5 to 3.6 and analgesic requirements were also diminished by local infiltration with saline before the episiotomy repair. It is postulated that the oedema of inflammation can be accommodated under less pressure if 'slack' is created by prior distension of the tissues.