Comparing administration of paracetamol for perineal pain

To assess the effect of two different methods of paracetamol administration on perineal pain management a prospective randomised clinical trial was conducted in a regional teaching hospital in the north west of England. Sixty primigravid women following a normal vaginal delivery who had sustained a first or second degree tear were randomised to have their pain managed using either self administration or staff administration of paracetamol. The primary outcome measure was the level of pain experienced at 48hours post delivery. Secondary outcome measures included — level of pain at 24hours, level of pain at 72hours, women's and midwives' satisfaction with the method of administration, number of paracetamol tablets taken, number of women requiring stronger analgesia and length of hospital stay. Data was retrieved from specifically designed questionnaires and a pain assessment chart. There was no difference in the median pain scores, length of hospital stay or number of women requiring additional analgesia. However, women in the self administration arm were more satisfied with their pain management (30/30 vs 20/30, P<0.01) when compared to the women in the staff administration arm. This finding was reinforced by the open responses. Similarly, midwives were more satisfied with self administration than staff administration. As the evidence on which to base the method of administration remains inconclusive further research is required. However, until such time, women should be allowed to choose their method of pain management.