الفهرس 
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Abstract
SUMMARY
P
ain of perineal trauma is considered one of the most health problems. Perineal trauma refers to any damage to the genitalia during vaginal delivery either spontaneously or due to episiotomy.
Different methods are applied to reduce pain during labor and the pain caused by episiotomy. Some of these methods include non-pharmaceutical methods such as hot packs, cold water compresses, and massage of the perineum, and pharmaceutical methods such as the use of local anesthetics (lidocaine gel or spray, lidocaine injection with or without vasoconstrictor). The most commonly used method is the injection of topical anesthetic. On the other hand, some other medical specialties have reported that the use of topical products such as sprays, gels, and creams/ointments are good alternatives to injectable anesthetics.
Topical analgesia means localized delivery of drug to the skin for pain relief through a local action on the peripheral sensory nerves and adjacent tissues. They carry many advantages as inducing a local effect without considerable systemic absorption, safety, ease of use and effectiveness.
Lidocaine prilocaine (LP) cream is an oil/water emulsion in which the oil phase consists of eutectic mixture of two different anesthetics: lidocaine 2.5% and prilocaine 2.5% in a ratio of 1:1 by weight. It is rapidly absorbed from the genital mucosa with an onset of action 5- 10 min from application. Its use was extensively studied in minor gynecological procedures as office hysteroscopy, intrauterine device insertion and hysterosalpingography with proved analgesic effect.
This cream has trivial side effects, which include tingling, coldness and warmth of the skin, pallor or redness of the skin, and swelling. Allergic or systemic reactions of the skin (rash or hives) are among the rare side effects. EMLA Cream is used widely in small pediatric, dermatology, and surgeries.
This randomized controlled clinical study was conducted at labor ward of Ain Shams University Maternity Hospital in the period between June 2019 and June 2020.
This study compared between lidocaine prilocaine cream and lidocaine injection on reduction of perineal pain during repair of perineal tears in women after childbirth.
The participants of this study were 180 parous women with uncomplicated pregnancy who were admitted on Ain Shams University Maternity Hospital for normal vaginal delivery of single fetus with cephalic presentation and gestational age more than 37 weeks.
Women, who refused to participate in the study, need episiotomy, epidural anesthesia and/or operative delivery “ventose or forceps”, with sensitivity to topical anesthetics, medical co morbidities “heart diseases, uncontrolled diabetes mellitus, neurological diseases that affect lower limb”, third or fourth degree perineal tears, cervical tears and/or use systemic or inhalation opium to reduce pain during labor were excluded from the study.
After vaginal delivery; the investigator inspected the perineum to identify the laceration, its degree and location. Then, the patients in need of perineal repair were allocated to intervention and control groups (each of them 90 women). Lidocaine prilocaine cream was used for the intervention group, and lidocaine was injected for the control group.
Statistical analysis of our results showed that there were no statistically significant differences between both groups regarding age (30.16 ± 4.332 vs. 29.93±4.313) (P= 0.800), gestational age (39.46 ± 1.123 vs. 39.33 ± 1.122) (P= 0.455), height (164.69 ± 8.258 vs. 163.63 ± 7.822) (P= 0.404), weight (69.52 ± 6.270 vs. 69.39 ± 5.501) (P= 0.892), BMI (25.81 ± 3.396 vs. 26.10 ± 3.347) (P= 0.561), degree of laceration (P= 0.778), duration of perineal repair (27.13 ± 4.727 vs. 27.27 ± 4.554) (P= 0.860), need for additional anesthesia (P= 0.536), pain VAS score (3.53 ± 0.985 vs. 3.60 ± 1.015) (P= 0.779) and patients satisfaction (P= 0.462).