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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Commonly used suture materials and techniques for perineal repair following vaginal delivery were compared in a randomized controlled trial involving 1574 women. Three comparisons were made using a modified factorial design. In the comparison of teflon-coated polyglycolic acid (Dexon plus) with chromic catgut for repair of the vagina and deep perineal tissues there was no clear difference other than less short-term analgesia being required in association with polyglycolic acid. Outcome was also similar after skin repair with either polyglycolic acid or chromic catgut or silk, although silk repair required more packets of material and was associated with delay in resuming sexual intercourse; polyglycolic acid was more likely to need removal than chromic catgut but it appeared to reduce the need for resuturing. There was no clear difference between continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin.
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PMID:The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma. 255 5

A systematic review of the 14 relevant controlled trials was conducted because there is no agreement about the choice of material and technique for repair of perineal trauma sustained during childbirth. Derivatives of polyglycolic acid (marketed as Dexon and Vicryl) appear to be the absorbable material of choice for both deep and skin closure. Compared with catgut their use is associated with about a 40% reduction in short-term pain and need for analgesia. The main drawback is that some material often needs removal during the puerperium. Glycerol-impregnated catgut is ruled out because of its link with long-term dyspareunia. Compared with the non-absorbable materials (silk and nylon) polyglycolic acid skin sutures were associated with less short-term perineal pain, and had no clear disadvantages. Continuous, subcuticular stitching appears preferable to interrupted, transcutaneous suturing, particularly in terms of perineal pain in the early puerperium.
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PMID:The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials. 255 6

Episiotomy is a very common operation but little is known of its short-term or long-term morbidity.A prospective study was designed to record postpartum perineal discomfort and to investigate the presence and persistence of dyspareunia following episiotomy in 140 primigravidae. A comparison was made between those whose perineal skin was sutured with a subcuticular polyglycolic acid (;Dexon') stitch and those sutured with interrupted black silk stitches.Patients sutured with subcuticular ;Dexon' had significantly less perineal discomfort on the third, fourth, and fifth postpartum days. Patients who had epidural analgesia in labour had significantly more pain during the first five postpartum days irrespective of the suture material used.The timing of first coitus after delivery did not influence the presence or persistence of dyspareunia. Dyspareunia was commoner and lasted longer in patients sutured with ;Dexon' and it was also commoner in older primigravidae irrespective of the suture technique.
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PMID:Pain after episiotomy--a comparison of two methods of repair. 700 31

Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in reducing obstetric trauma, and also the role of pelvic floor and general exercise in pelvic floor recovery after childbirth.
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PMID:Minimizing genital tract trauma and related pain following spontaneous vaginal birth. 1746 91