{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:01:23Z","timestamp":1792695683171,"version":"4.5.0"},"reference-count":94,"publisher":"BMJ","issue":"6","funder":[{"DOI":"10.13039\/501100011955","name":"European Society of Regional Anaesthesia and Pain Therapy","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100011955","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,4,27]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A vaginal delivery may be associated with acute postpartum pain, particularly after perineal trauma. However, pain management in this setting remains poorly explored.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The aim of this systematic review was to evaluate the literature and to develop recommendations for pain management after a vaginal delivery with perineal trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Evidence review<\/jats:title>\n                  <jats:p>MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and systematic reviews assessing pain after a vaginal delivery with perineal tears or episiotomy until March 2023. Cochrane Covidence quality assessment generic tool and the RoB Vis 2 tool were used to grade the quality of evidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Overall, 79 studies (69 RCTs and 10 systematic reviews and meta-analyses) of good quality of evidence were included. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment. Epidural morphine (\u22642\u2009mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring. Local anesthetic infiltration, topical local anesthetic, ointment application, and pudendal nerve block are not recommended due to insufficient or lack of evidence. Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use. Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants. When a perineal suture is indicated, a continuous suture compared with an interrupted suture for the repair of episiotomy or second-degree perineal tears is recommended for the outcome of pain. For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Postpartum pain management after a vaginal delivery with perineal trauma should include acetaminophen, NSAIDs, and ice or chemical cold packs. Epidural morphine should be reserved for severe perineal tears. A surgical repair technique should depend on perineal tear severity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2024-105478","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T02:50:17Z","timestamp":1716259817000},"page":"503-513","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Acute pain management after vaginal delivery with perineal tears or episiotomy"],"prefix":"10.1136","volume":"50","author":[{"given":"Xavier","family":"Luxey","sequence":"first","affiliation":[{"name":"Anesthesiology and Intensive Care Medicine, H\u00f4pital Armand-Trousseau, DMU DREAM, AP-HP, Paris, \u00cele-de-France, France"},{"name":"H\u00f4pital de la Timone service d'anesth\u00e9sie r\u00e9animation 1, Marseille, Provence-Alpes-C\u00f4te d'Azur, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9181-7283","authenticated-orcid":false,"given":"Adrien","family":"Lemoine","sequence":"additional","affiliation":[{"name":"Anesthesia, Intensive Care and Perioperative Medicine, Tenon Hospital, DMU DREAM, AP-HP, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geertrui","family":"Dewinter","sequence":"additional","affiliation":[{"name":"Biomedical Sciences Group, Department of Cardiovascular Sciences, Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish P","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Le Ray","sequence":"additional","affiliation":[{"name":"Port Royal Maternity Unit, Cochin Hospital, Universit\u00e9 Paris Cit\u00e9, APHP, Paris, \u00cele-de-France, France"},{"name":"Centre for Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOP\u00e9, INSERM, INRA, INSERM, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Raeder","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, department of Anesthesiology, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Van de Velde","sequence":"additional","affiliation":[{"name":"Biomedical Sciences Group, department of cardiovascular sciences, Department of anesthesiolgy, University Hospitals Leuven, Leuven, Vlaams-Brabant, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2055-8813","authenticated-orcid":false,"given":"Marie-Pierre","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOP\u00e9, INSERM, INRA, INSERM, Paris, \u00cele-de-France, France"},{"name":"Department of Anesthesiology and Intensive Care Medicine, Armand Trousseau Hospital, DMU DREAM, GRC29, Sorbonne University, APHP, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"key":"2025101111572332000_50.6.503.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2007.00207.x"},{"key":"2025101111572332000_50.6.503.2","first-page":"e35","article-title":"Acog committee opinion no. 742: postpartum pain management","volume":"132","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2025101111572332000_50.6.503.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2008.07.011"},{"key":"2025101111572332000_50.6.503.4","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/jog.15850","article-title":"Postpartum pain and the risk of postpartum depression: A meta-analysis of observational studies","volume":"50","author":"Lu","year":"2024","journal-title":"J Obstet Gynaecol Res"},{"key":"2025101111572332000_50.6.503.5","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15339"},{"key":"2025101111572332000_50.6.503.6","first-page":"948","article-title":"Perineal tears and Episiotomy: surgical procedure - 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The effects of lidocaine and mefenamic acid on post-Episiotomy pain: a comparative study. Shiraz E Med J 2016;17.doi:10.17795\/semj36286","DOI":"10.17795\/semj36286"},{"key":"2025101111572332000_50.6.503.51","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/NMC.0000000000000165","article-title":"Hydrocortisone cream to reduce Perineal pain after vaginal birth: A randomized controlled trial","volume":"40","author":"Manfre","year":"2015","journal-title":"MCN Am J Matern Child Nurs"},{"key":"2025101111572332000_50.6.503.52","doi-asserted-by":"crossref","unstructured":"Golezar S . Ananas Comosus effect on Perineal pain and wound healing after Episiotomy: a randomized double-blind placebo-controlled clinical trial. Iran Red Crescent Med J n.d.;18.doi:10.5812\/ircmj.21019","DOI":"10.5812\/ircmj.21019"},{"key":"2025101111572332000_50.6.503.53","doi-asserted-by":"crossref","unstructured":"Cheshfar S . Effects of ginger (Zingiber Officinale) extract ointment on pain and Episiotomy wound healing in nulliparous women: a randomized controlled clinical trial, 2022. 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