Comparison of Efficacy of Lignocaine Jelly versus Lignocaine Injection during Perineum Repair in Normal Vaginal Delivery

Abstract

Background: Normal vaginal delivery is frequently associated with perineal trauma that can be iatrogenic (episiotomy) or spontaneous. Episiotomy is the most common surgical procedure in obstetrics being performed in approximately 20% of deliveries Objective: To compare the efficacy of lignocaine Jelly versus lignocaine injection during perineum repair after episiotomy in normal vaginal delivery. Methods: Study was done at Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore during September 2020 - Feb 2021. For this randomized control trial, a total of 160 women fulfilling selection criteria were recruited for study from labour room. Informed consent was obtained from each case. Women were then segregated in group A& B and treatment was randomly allotted using lottery method, while in group A 2% lignocaine Jelly was applied on their perineum during active phase of labour at 8-9 cm cervical dilatation, before estimated time of one hour pre delivery. Women in group B were administered 10 ml of 1% lignocaine injection locally at the proposed site of episiotomy just before crowning. Then females were observed for pain and discomfort or adverse reactions during delivery, perineal repair and in immediate post partum period. After 2 hours of delivery, females were asked for perineal pain using visual analogue scale (VAS) then females were followed up in post-delivery wards for 12 hours. After 12 hours, they were discharged and asked for satisfaction of procedure. Results: The average ages of the cases among Group-A i.e. Lignocaine Jelly group and Lignocaine injection group (group-B) was 26.20 ± 3.32 years and 26.46 ±3.47 years respectively. The mean gestational age in Lignocaine Jelly group was 38.65 ± 0.90 weeks and in Lignocaine injection group was 38.67 ± 0.87 weeks. The mean BMI in Lignocaine Jelly and injection group was 26.70 ± 1.39 and 26.46 ± 2.20 respectively. Average pain score observed in Lignocaine Jelly was 3.58±1.06, whereas in Lignocaine injection group was 4.39 ± 1.26. There was statistically significant difference in average pain scores as the mean pain score in the Lignocaine Jelly group was lower compared with Lignocaine injection group ( p-value ≤ 0.001). In Lignocaine Jelly group 77(96.2%) females were satisfied while in Lignocaine injection group 68(85%) cases were satisfied, higher satisfaction rate was seen in lignocaine Jelly group, p-value (0.015) Conclusion: Women to whom lignocaine Jelly was applied before episiotomy had less mean VAS Pain Score and higher satisfaction rate during perineal repair than women who were given lignocaine injection for perineal repair. So lignocaine Jelly can be used as a good alternative of local infiltration of lignocaine injection, in term of less pain, less adverse effects and more patient satisfaction during perineal repair of birth process.