NSAIDs and Acetaminophen for perineal trauma after delivery

Acetaminophen, ice or chemical cold packs and NSAIDs can be used for postpartum pain relief after vaginal delivery with perineal laceration or episiotomy after childbirth.

This systematic review aimed to analyze the existing pieces of literature and develop recommendations for acute pain management post-vaginal delivery with a perineal laceration.

MEDLINE, Embase, and Cochrane databases were searched and found relevant 79 studies (69 randomized controlled trials and 10 systematic reviews/meta-analyses) to be included in the analysis. Quality assessment was conducted using the Cochrane Covidence tool and RoB Vis 2, indicating overall good quality of evidence.

The study recommended Acetaminophen and NSAIDs as first-line treatments for pain relief after vaginal delivery with perineal tears or episiotomy. Epidural morphine (≤2 mg) was suggested for severe perineal tears in women receiving labour epidural analgesia, with careful respiratory monitoring.

Topical local anaesthetic, local anaesthetic infiltration, pudendal nerve block, and ointment application were discouraged due to insufficient evidence. Ice or chemical cold packs were favoured to ease pain after delivery due to their ease of use. Acupuncture and transcutaneous nerve stimulation were recommended as supplementary therapies.

Continuous suturing was chosen over interrupted suturing for repairing episiotomy or second-degree perineal tears to lessen pain. No suturing or glue was advised over suturing to minimize pain outcomes for first-degree or second-degree tears.

NSAIDs, Acetaminophen and ice or chemical cold packs are effective for managing postpartum pain following vaginal delivery with perineal trauma. Epidural use of morphine is suggested for cases involving severe perineal tears. The severity of the perineal tear determines the preference of the surgical repair technique to be used.