A randomized controlled trial of lidocaine versus ropivacaine for pain relief after episiotomy

Introduction: Episiotomy is the most common surgical procedure for parturient. Analgesia after episiotomy has received less attention, though the postepisiotomy pain may hamper the day-to-day activities such as sitting, sleeping, urinating, and walking of the parturient. It is desirable to reduce the postepisiotomy pain as early as possible. Therefore, we planned to carry out a randomized controlled trial to compare the safety and efficacy of lidocaine versus ropivacaine perineal infiltration for pain relief after episiotomy. Materials and Methods: The prospective randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology of R. G. Kar Medical College and Hospital, Kolkata. One hundred women were enrolled and randomized into the two groups: Lidocaine infiltration group and ropivacaine infiltration group. Primary objective was to evaluate the efficacy of postepisiotomy pain control by the visual analog scale (VAS) score at 24 h after the episiotomy. Secondary objectives were to evaluate the efficacy of postepisiotomy pain control by VAS score during suturing, at 2 h and 48 h or any adverse effects and maternal satisfaction at 48 h. Results: The postepisiotomy pain relief at 2 h and 24 h was significantly lower in ropivacaine in comparison to lidocaine infiltration. Mean VAS Score 24 h after suturing in lidocaine group was 6.38, and in ropivacaine group, it was 5.64. Maternal pain perception at the time of suturing and at 48 h was also less in ropivacaine than in lidocaine infiltration. Mothers were more satisfied with ropivacaine drug. Conclusion: The present study showed that there was definite improvement of postepisiotomy pain relief at 2 h and 24 h in ropivacaine local infiltration of the episiotomy wound in comparison to lidocaine infiltration and mothers were more satisfied with ropivacaine use.