Aspirin May Improve Perineal Pain After Episiotomy

Acute postpartum perineal pain is common after vaginal birth that is complicated by perineal trauma, such as spontaneous tears or episiotomy.
Acute postpartum perineal pain is common after vaginal birth that is complicated by perineal trauma, such as spontaneous tears or episiotomy.

Single-dose aspirin may provide relief of perineal pain after episiotomy in women who are not breastfeeding, according to a study published in Cochrane Database of Systematic Reviews.1

Acute postpartum perineal pain is common after vaginal birth that is complicated by perineal trauma, such as spontaneous tears or episiotomy, and may occur even if perineal trauma is absent. Perineal pain in the immediate postpartum period can interfere with a woman's ability to care for and breastfeed her newborn child.1,2 Some women go on to develop chronic perineal pain.

Data supporting the use of pain relief measures, such as paracetamol and local cooling (eg, ice packs) of the perineum, are limited.3,4 Single-dose aspirin has been shown to provide effective analgesia in patients with acute postoperative pain, but has not been evaluated in women with acute perineal pain postpartum.5

Researchers investigated the efficacy of single-dose aspirin for providing relief of acute perineal pain in the immediate postpartum period in a systematic review.1

Data from 1132 women from 16 randomized controlled trials (RCTs) and an unspecified number of women from 1 RCT were included for analysis. All women in these trials underwent episiotomy, experienced perineal pain, and were not breastfeeding.

Women treated with a single dose of aspirin (300 mg, 500 to 650 mg, 900 mg, or 1200 mg) were more likely to report adequate pain relief than women receiving placebo over 4 to 8 hours after drug administration (risk ratio [RR], 2.03; n = 1001; 13 RCTs).

Aspirin use also decreased the need for additional analgesia over 4 to 8 hours post-dose compared with placebo (RR, 0.25; n = 744; 10 RCTs). The rates of adverse events were similar in women receiving aspirin and women receiving placebo.

No differences in rates of adequate pain relief, need for additional pain relief, or maternal adverse events were observed for the 300-mg, 600-mg, and 1200-mg doses of aspirin.

Summary and Clinical Applicability

Acute postpartum perineal pain is common after vaginal birth, can adversely affect neonatal care in the short-term, and may develop into chronic pain in the long-term. Researchers conducted a systematic review evaluating the efficacy of single-dose aspirin in acute perineal pain in the immediate postpartum period. Aspirin was more effective than placebo at providing pain relief and reducing the need for additional analgesia in women who had undergone episiotomy and were not breastfeeding.

“With international guidance recommending mothers initiate breastfeeding within one hour of birth, and exclusively breastfeed for the first six months, the evidence from this review is not applicable to current recommended best practice. Aspirin may be considered for use in non-breastfeeding women with post-episiotomy perineal pain,” the researchers wrote.

“Current research has focused on women with post-episiotomy pain, future RCTs could be extended to women with perineal pain associated with spontaneous tears or operative birth,” they wrote.

Limitations

The RCTs in the meta-analysis only included women who had perineal pain post-episiotomy and were not breastfeeding, limiting the generalizability of the results.

The overall quality of evidence was low due to potential risk for bias and unclear methodology in the RCTs.

 

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References

  1. Molakatalla S, Shepherd E, Grivell RM. Aspirin (single dose) for perineal pain in the early postpartum period. Cochrane Database Syst Rev. 2017;2:CD012129. doi: 10.1002/14651858.CD012129.pub2
  2. East CE, Sherburn M, Nagle C, Said J, Forster D. Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 2012;28(1):93-97. doi: 10.1016/j.midw.2010.11.009
  3. East CE, Begg L, Henshall NE, Marchant PR, Wallace K. Local cooling for relieving pain from perineal trauma sustained during childbirth. Cochrane Database Syst Rev. 2012;(5):CD006304. doi: 10.1002/14651858.CD006304.pub3
  4. Chou D, Abalos E, Gyte GM, Gülmezoglu AM. Paracetamol/acetaminophen (single administration) for perineal pain in the early postpartum period. Cochrane Database Syst Rev. 2013;(1):CD008407. doi: 10.1002/14651858.CD008407.pub2
  5. Derry S, Moore RA. Single dose oral aspirin for acute postoperative pain in adults. Cochrane Database Syst Rev. 2012;(4):CD002067. doi: 10.1002/14651858.CD002067.pub2
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