Lidocaine versus ropivacaine for perineal infiltration post-episiotomy.

Objective: To evaluate maternal analgesia after an episiotomy during delivery.

Methods: The present case-control study compared 2 protocols of post-episiotomy infiltration: period A, 20 mL of lidocaine 10mg/mL; period B, 20 mL of ropivacaine 7.5mg/mL. The primary study endpoint was the visual analog scale (VAS) score at 24 hours after episiotomy; secondary endpoints were the VAS scores during suturing and at 2 and 48 hours, and patient satisfaction at 48 hours.

Results: In total, 102 women were included in the study. The median VAS score at 24 hours was significantly lower during the ropivacaine period (3 [1.5-4]) than during the lidocaine period (4 [2-6]; P=0.004). A VAS score below 4 at 24 hours was significantly more frequent with ropivacaine (71% versus 43%; P=0.009). The VAS scores at 2 and 48 hours were also lower in the ropivacaine group (2 hours, 0 [0-1] versus 1 [0-3], P=0.01; and 48 hours, 2 [0-3] versus 3 [2-5], P<0.001). Maternal satisfaction was significantly higher in the ropivacaine group.

Conclusion: Analgesia and maternal satisfaction were improved during the period when ropivacaine was used as opposed to lidocaine. The effect lasted for up to 48 hours.