Comparative study of eutectic mixture of Lignocaine - Prilocaine (EMLA) cream and Lignocaine infiltration for pain relief during episiotomy and its repair

Abstract

Background: To study the effect of topically applied EMLA cream in reduction of pain during episiotomy and its repair after childbirth and to compare its effectiveness with local anesthetic lignocaine infiltration. Methods: Hundred primigravida women were assigned randomly in a 1:1 ratio to receive either the lignocaine infiltration (Group I) or the application of EMLA cream (Group II) for pain relief during episiotomy and its repair. The primary outcome was the difference in mean pain score during episiotomy and its repair. Secondary outcomes included the participants’ satisfaction and the need for additional anesthesia. Results: Women in the lignocaine infiltration group (Group I) had significantly lower mean pain scores during episiotomy and its repair than those in the EMLA cream group (Group II) (3.76 ± 1.0 versus 4.2 ± 1.2; P = 0.030057). The need for additional anesthesia was more in Group II than Group I (8/50 versus 17/50; P = 0.018). However, the proportion of women who expressed satisfaction with anesthesia method in the EMLA group was statistically comparable with the lignocaine infiltration group (86% versus 78%; P = 0.14). Conclusions: EMLA cream may be less active on the perineal muscular layers than local infiltration of lignocaine due to limited penetration beneath the skin, which could account for higher requirement of additional analgesia. The cream appears to be a safe, easy to use, effective and satisfactory alternative to local anesthetic infiltration for the pain relief during episiotomy and its repair and is better tolerated on account of reduced needle anxiety and painful injections especially in the rural areas, which lack trained personnel.