Shahin Navvabi, Zahra Abedian, Mary Steen-Greaves

British Journal of Midwifery, Vol. 17, Iss. 11, 05 Nov 2009, pp 724 - 729

This article reports the findings of a randomized controlled trial undertaken at the Hazrat Ommolbanin University Maternity Hospital in Mashhad, Iran, which investigated the effectiveness of localized cooling treatments to alleviate perineal trauma. From October 2005 to February 2006, 121 primiparous women who were at term and had an episiotomy were randomly recruited to one of three treatment groups (Group 1 - no localized cooling; Group 2 - Ice pack; Group 3 - cooling gel pad). The intensity of pain, wound healing and women's satisfaction levels were the main outcomes measured. The intensity of pain was measured by a Numeric Rating Scale (NRS) (1-10) and wound healing was evaluated by the REEDA scale within 4 hours of episiotomy repair; at days 1, 2, 5 and 10. The use of oral analgesia was measured at day 10. Women's satisfaction levels with oral analgesia and localized cooling treatments were also assessed at day 10 by a NRS.
There was evidence that localized cooling treatments are effective in alleviating perineal pain, which was in favour of the cooling gel pad group. A statistical significant difference was reported at 4 hours (P=0.003); day 2 (P=0.004); and at day 10 (P=0.044). At days 1 and 5 there was evidence of a reduction in the intensity of pain but this did not reach a statistical significant difference. A reduction in the use of oral analgesia was reported in favour of the cooling gel pad group (P<0.001). Women's satisfaction levels with oral analgesia were similar within the three treatment groups but a higher level of satisfaction when assessing localized treatment was reported by the cooling gel pad group (P<0.001). Wound healing rates were also reported to be better in the cooling gel pad group when compared to the other two groups (P<0.001). Women's views and treatments to alleviate perineal pain without any adverse affects on wound healing are important aspects of midwifery care. This trial has demonstrated evidence that localized cooling of the perineum reduces the intensity of pain. Women were more satisfied when applying cooling gel pads and this treatment appeared to assist in wound healing.

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