Objective: To carry out feasibility study and determine the effect of local lidocaine in reducing the rate of maternal perineal incision. Method: A retrospective study of our hospital in January 2010 January 2012, with 80 cases of local application of lidocaine after perineal side cut lying in women and in the same period were randomly selected and 100 cases of conventional guild shade side cut of mother’s surgery as control group. Results: There was no difference between the weight of the newborn and the experimental group at the time of birth. The use of local lidocaine can reduce the rate of maternal perineal incision. Besides, in experimental group it show reduce in maternal postpartum hemorrhage and incision infection, with not increase the incidence of neonatal asphyxia. Conclusion: The use of local lidocaine in reduce the rate of maternal perineal incision is a simple, safe and reliable method to reduce the pain during delivery

Song, Yan

Xue, Wenying

Yin, Xinhong

Advanced Emergency Medicine

&lt;strong&gt;Objective: &lt;/strong&gt;To carry out feasibility study and determine the effect of local lidocaine in reducing the rate of maternal perineal incision. &lt;strong&gt;Method: &lt;/strong&gt;A retrospective study of our hospital in January 2010 January 2012, with 80 cases of local application of lidocaine after perineal side cut lying in women and in the same period were randomly selected and 100 cases of conventional guild shade side cut of mother’s surgery as control group. &lt;strong&gt;Results: &lt;/strong&gt;There was no difference between the weight of the newborn and the experimental group at the time of birth. The use of local lidocaine can reduce the rate of maternal perineal incision. Besides, in experimental group it show reduce in maternal postpartum hemorrhage and incision infection, with not increase the incidence of neonatal asphyxia. &lt;strong&gt;Conclusion: &lt;/strong&gt;The use of local lidocaine in reduce the rate of maternal perineal incision is a simple, safe and reliable method to reduce the pain during delivery.</jats:p

Xinhong Yin

Wenying Xue

Yan Song

Crossref

Clinical Study on Local Application of Lidocaine in Reducing the Rate of Maternal Perineal Incision

Objective: To carry out feasibility study and determine the effect of local lidocaine in reducing the rate of maternal perineal incision. Method: A retrospective study of our hospital in January 2010 January 2012, with 80 cases of local application of lidocaine after perineal side cut lying in women and in the same period were randomly selected and 100 cases of conventional guild shade side cut of motherâ€™s surgery as control group. Results: There was no difference between the weight of the newborn and the experimental group at the time of birth. The use of local lidocaine can reduce the rate of maternal perineal incision. Besides, in experimental group it show reduce in maternal postpartum hemorrhage and incision infection, with not increase the incidence of neonatal asphyxia. Conclusion: The use of local lidocaine in reduce the rate of maternal perineal incision is a simple, safe and reliable method to reduce the pain during delivery

Advanced Emergency Medicine (E-Journal)

10   |   Volume 1   |   December 20121. Introduction1During the second stage of labor or delivery process, epi-siotomy is at the end process of delivery. Usually it makes a lateral shear perineum, and involve suture repair of an expansion of vaginal opening surgery. There are two ways of the operation, including the perineal incision and the lateral incision. The purpose of the perineal incision was to prevent severe laceration of the perineal III. At present, there is a gradual increase in the rate of perineal incision in domestic natural labor. A survey report from the Shanghai pointed out that the rate of the first three hospitals in the lateral cut rate of early maternal achieving 82.7−95.61% [1]. Hence, there is a lot of women try to avoid this opera-tion by choose cesarean section as termination of preg-nancy. Due to its special location, after incision of perineal, it often causes some complications, such as postpartum incision infection, pain, edema and inflammation bowel syndrome etc., besides that, the infection rate of perineal Copyright © 2012 Xinhong Yin et al.doi: 10.18686/aem.v1i1.4Received: August 7, 2012; Accepted: October 12, 2012; Published online: November 17, 2012This is an open-access article distributed under the terms of the Creative Commons Attribution Unported License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.*Corresponding author: Wuxi Maternity and Child Health Care Hos-pital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214002, China. E-mail: zxl_yuhuan@163.comincision was achieved 10% in overall cases [2]. Moreover, the toughness of the women’s pelvic floor muscle tissue re-duced, hence it increase the difficulty during sexual inter-course and the symptoms of perineal pain. Hence, to reduce the rate of perineal side incision, the research found that the effective administration of lidocaine able to reduce the ma-ternal perineal incision rate, and the report was as follows.2. Materials and methods2.1. General informationFrom January 2010 to January 2012, 80 cases of pregnant women from our hospital were selected for transperineal application of topical lidocaine after perineal side incision method of midwifery. All enrolled were absent for mater-nal fetal distress, second stage of labor extended to vagi-nal delivery, or for primipara physical causes of disease to shorten the second stage of labor. 100 cases of pregnant women was randomly selected as the control group, which used Lamaze method for the conventional episiotomy. Two groups of maternal pelvic measurements of the normal head basin were not known, and absence of prolonged sec-ond stage of labor, fetal distress and other phenomena. The baby weights were in between 2,600−4,200 g and gesta-tional weeks between 37−42 weeks of full-term primipara from.2.2. The use of lidocaine20 mL of 2% lidocaine was diluted with saline to achieve 1:1 mixture solution. Ordinary intramuscular needle was used KEYWORDSAnalgesicPerineal incisionLidocaineABSTRACT  Objective: To carry out feasibility study and determine the effect of local lidocaine in reducing the rate of maternal perineal incision. Method: A retrospective study of our hospital in January 2010 January 2012, with 80 cases of local application of lidocaine after perineal side cut lying in women and in the same period were ran-domly selected and 100 cases of conventional guild shade side cut of mother’s surgery as control group. Results: There was no difference between the weight of the newborn and the experimental group at the time of birth. The use of local lidocaine can reduce the rate of maternal perineal incision. Besides, in experimental group it show reduce in ma-ternal postpartum hemorrhage and incision infection, with not increase the incidence of neonatal asphyxia. Conclusion: The use of local lidocaine in reduce the rate of maternal perineal incision is a simple, safe and reliable method to reduce the pain during delivery.Clinical Study on Local Application of Lidocaine in Reducing the Rate of Maternal Perineal IncisionXinhong Yin*, Yan Song and Wenying XueWuxi Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214002, ChinaORIGINAL ARTICLEXinhong Yin et al.Volume 1   |   December 2012   |   11Advanced Emergency Medicinein injection for the administration of lidocaine solution. 4 point method is usually applied during the administration of lidocaine, which injection directly into the genital, so that the vulva can be fully relaxed. The iodophor prepara-tion was used in disinfection of vulva skin and the original side cut of perineum which from outside or from the in-side out injection of lidocaine. At the same time, perineal deep, superficial transverse muscle, first half of the external anal sphincter and lower edge of the symphysis pubis was injected with lidocaine from top into bottom. Local anes-thesia can also be applied with margin level to ball sponge body and ischiocavernous muscles at pubic symphysis. If the descending of fetal head is rapid, the administration of lidocaine can be earlier. Meanwhile, the use of lidocaine is not urgent for cases where the fetal is ready.If mothers still sense serious vulva or due to fetal distress after local anesthesia of lidocaine, there was still need for the vaginal delivery, which close based uplink sacral perineal re-section. Precaution should be taken that clinical maximum dose of lidocaine as local anesthesia was 4,000 mg.3. Statistical methodsThe measurement data were compared with Levene’s test, and the variance was analyzed by single factor analysis of variance. Two groups of count data analyzed by using the 2 tests, statistical analysis with SPSS 12.0, and p < 0.05 shown significant differences.4. Results4.1. General information comparisonThere was no difference in the age of the pregnant women and the average gestational weeks of the patients in the treatment group and the patients in the control group. The two groups had no statistical significance (p > 0.05). Lido-caine group 80 cases of patients without episiotomy, post-partum perineal laceration were within 2 degrees, with no grade III or IV degree perineal crack injured and perineal laceration of one-stage healing.4.2. Lidocaine group and the perineal side incision group of neonatal birth weightThere was no significant difference in the body weight dis-tribution between the lidocaine group and the perineal side incision group (p > 0.05).4.3. Lidocaine group and the perineal side incision group of maternal postpartum comparisonIn the newborn infants with mild asphyxia, 5 cases were treated with lidocaine and 6 cases with perineal side in-cision group, where 1 cases were treated with lidocaine group and perineal side incision. In postpartum hemor-rhage and lidocaine group had 2 cases, and perineal side incision group had 3 cases; on the second stage of exten-sion, both groups each have 2 cases. There was no signifi-cant difference in mild and severe asphyxia rate between both groups (p > 0.05). There was absence of incision in-fection in the lidocaine group which significant difference between the groups (p < 0.05). There was no significant difference in the incidence of postpartum hemorrhage be-tween lidocaine group and perineal side incision group (p > 0.05). There was no significant difference in the second stage of labor time of both group (p > 0.05).5. DiscussionPerineal side cut will permanently destroy the vaginal mu-cous membrane, perineal body skin, subcutaneous tissue and even the muscle structure of the anus. The incidence of post-operative pain and the incidence of postpartum sexual life was significantly higher in the patients with perineal incision. 1996 international organizations put forward on “Aimu intrapartum ten delivery action” that delivery is a normal physiological process, routine interventions should not be used in. One precaution should be taken that lateral cut rate must be limited within 10−20%. While the perineal Table 2. Comparison of body weight in the lidocaine group and the perineal side incision group.Neonatal body weight < 3.0 kg 3.0‒3.5 kg 3.5‒3.75 kg 3.5‒4.0 kg 4.0‒4.25 kgLidocaine group 4 17 35 15 9Perineal side incision 5 22 42 21 10p > 0.05 - - - -Table 3. Comparison of the conditions of the pregnant women and the newborns of the lidocaine group and the perineal side in-cision.Grouping Mild neonatal asphyxiaNeonatal severe asphyxiaWound infectionPostpartum hemorrhageProlonged second stage of laborLidocaine group (case) 5 1 0 2 2Perineal side incision group (case) 6 1 8 3 2p > 0.05 > 0.05 < 0.05 > 0.05 > 0.05Table 1. Comparison of the general data of the lidocaine group and the perineal side incision group.Clinical data Lidocaine groupPerineal side incision p ValueAverage age (Y)Gestational weeks (W)Maternal weight (kg)27.638.168.827.937.867.50.3180.4310.55912   |   Volume 1   |   December 2012incision of the maternal pain is very obvious, and pain is dis-advantage and is the patient’s right to avoid it [3]. Therefore, controlling the rate of lateral cut had increasing important.Lidocaine is mainly used for infiltration anesthesia, epi-dural anesthesia, surface anesthesia (including the use of the use of mucosal anesthesia during the operation of the chest or abdomen. It belongs to the local anesthetic drugs, which can be absorbed by the blood in the way of intra-venous administration. It has the effect of inhibiting and exciting central nervous system. After administration the drugs will absorb rapidly into the patient’s blood circula-tion system, and finally distribute into all the muscle tissue. The therapeutic effect can achieve after 5 min and 200 mg of lidocaine injection which was the therapeutic concen-tration, had 90 min of sustainable effect. The adverse ef-fect included dizziness, nausea, unconsciousness and other symptoms. Excessive doses may produce severe cardiac dysfunction and other side effect. In addition, patients may experience allergic reactions, hence once the develop of edema and rash, should immediately discontinue the drug. However, the administration of lidocaine prohibited when there is a patient in the presence of myocardial damage, liver dysfunction, low blood volume, kidney dysfunction or shock. Reduce the dosage of lidocaine for the patients that suffering from heart and liver disease. Due to the properties of lidocaine which can be both analgesic, and muscle relaxer, so, during the natural delivery, injection of lidocaine into the inner part of the vulva, induce vulva muscle relaxation, and reduce the degree of perineal lac-eration. After local anesthesia, rubbing with sterile gauze gently, so that the drug dispersed into the muscular layer. After gave birth to the head of the fetus, the index finger and middle finger can be used with sterile gloves to de-termine whether the vulva was in nervous stage. After the crowning of the vulva can still be placed in two fingers, the vulva usually won’t break up too serious. The patient can feel vulva nervous under local anesthesia, and feeling of re-laxation immediately after using lidocaine. The correct use of intra-operative guidance maternal abdominal pressure, the successful completion of vaginal delivery of fetus [4].The clinical application of lidocaine perineal anesthesia method, decrease the rate of natural childbirth primipara perineal resection nearly up to 25%. At the same time, li-docaine is particularly suitable for vulva muscles that are active, thicker tissue layer, poor elasticity, with lateral epi-siotomy operative indications of primipara [5]. Neonatal weight of lidocaine group and control group had no statis-tical significance difference in between. It except for fetal distress or the second stage of labor extended for vaginal delivery, or for primipara’s physical causes of disease re-quired shorten the second stage of labor of maternal, aver-age weight of newborn can be used topical lidocaine ap-plication, also do not need to episiotomy. It is significantly shown that the maternal wound infection rate of lidocaine group had decreased, beside that it able to reduce the ma-ternal pain and shorten the length of hospital stay [5].In the present study, the patients with mild asphyxia, se-vere neonatal asphyxia, wound infection and postpartum hemorrhage, were generally superior to that of the patients in the group of patients with mild asphyxia. But there are also some contraindications of lidocaine, if the injection of the drug before delivery, within a few minutes, the concen-trations of drug in fetuses can reach half of mother drug concentration. It has been reported that before delivery lidocaine induce slow heartbeat in fetal and even lead to methemoglobinemia. Therefore, before delivery of drug injection, the comparison of the advantages and disadvan-tages should take in as the consideration.In addition, although the perineal skin muscle has a certain elastic, but it cannot expand unlimited. So the ex-tension of fetal head should switch to the supporting anus method. Then left hand to support fetal scalp and forehead, and assist the fetal head extension. When the contractions become stronger, enjoin maternal breathing using mouth. Until intermittent contractions occur then use abdominal pressure to slowly release of childbirth fetal head and with local use of lidocaine it will avoid perineum laceration. Therefore, lidocaine local anesthesia is simple, widely ap-plicable methods that help in reduce maternal pain.Conflicts of interestThese authors have no conflicts of interest to declare.Authors’ contributionsThese authors contributed equally to this work.ReferencesOu XQ, Deng GL. 31 episiotomy wound and counter-1. measure analysis of bad. Chinese Journal of Nursing. 2005;12(4):22.Ye GX, Mei HD, Zheng WW. 0.30 degree perineal cut 2. healing with pain clinical observation. Chinese Journal of Nursing. 2002;37(5):394—395.Li XF, Chen HJ, Ding MH. The management and research 3. of labor pain management and research progress. Jour-nal of Nursing. 2007;14(1):29.Lu RG, Huang Y, Chen LM, et al. To reduce the rate of 4. perineal side incision in the delivery. Zhejiang Preventive Medicine. 2010;22(3):59—60.Xie CL, Zhang HY, Huang MM, et al. A case control study 5. on the normal delivery of the perineal side of the low risk women with normal delivery. Journal of Modern Nursing. 2011;18(9):10—12.Xinhong Yin et al.

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Clinical Study on Local Application of Lidocaine in Reducing the Rate of Maternal Perineal Incision

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