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Randomized Trial of Lidocaine Ointment Versus Placebo for the Treatment of Postpartum Perineal Pain

From the Division of Urogynecology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Maternal Fetal Medicine, Bellin Health Hospital Center, Green Bay, Wisconsin; and Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Lubbock, Texas.

Address reprint requests to: Vatche A. Minassian, MD, 33 Davisville Avenue, #415, Toronto, Ontario M4S 2Y9, Canada; E-mail: vatche.minassian{at}utoronto.ca.

OBJECTIVE: To estimate the efficacy of lidocaine ointment in relieving pain after a vaginal delivery with an episiotomy or perineal laceration.

METHODS: In a randomized, double-blind, placebo-controlled trial, 200 women received lidocaine ointment (n = 108) or a placebo (n = 92). Pain relief was assessed by the amount of ointment used (weight of jar before use (weight of jar after use), total number of pain pills used, and a pain questionnaire. The sample size was calculated using a ß of .2 and an ß of .05 with an expected reduction of other pain medications from an average use of six pills to four pills for the population.

RESULTS: There was no significant difference in the amount of lidocaine versus placebo used for postpartum day 1 (5.1 g versus 4.0 g, respectively [P =.13]) or day 2 (3.7 g versus 2.6 g, respectively [P = 18]). Patients receiving lidocaine instead of the placebo showed no significant difference in the total amount of postpartum pain medications (6.3 versus 6.8 tablets, respectively [P = .53]), subjective pain parameters (P = .36), or satisfaction from ointment (P = .99). Patients with an episiotomy used more pain medications than those with a laceration (7.9 versus 5.6 tablets, respectively [P = .003]). Those with minor versus major lacerations required fewer pain pills (6.1 versus 10.8 tablets, respectively [P < .001]) and used less ointment (4.3 g versus 7.9 g, respectively [P = .02]) on the first postpartum day.

CONCLUSION: Topical application of 5% lidocaine ointment was not effective in relieving episiotomy or perineal laceration pain.

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