Effectiveness of Topical 2% Lidocaine Gel for Post-episiotomy Pain Relief: A randomized, Double-blind trial

Objectives: To evaluate the effectiveness and safety of topical 2% lidocaine gel versus a placebo for post-episiotomy analgesia, assessed using the numeric rating scale (NRS) pain scores at 6, 12, and 24 hours postpartum. Materials and Methods: This randomized, double-blind, placebo-controlled trial was conducted at a tertiary care hospital in Thailand. A total of 184 women who underwent vaginal delivery with episiotomy were randomized to receive topical 2% lidocaine gel (n = 92) or placebo gel (n = 92), applied as a thin layer to the perineal wound every 4 hours for 12 hours post-repair. Pain was assessed with the NRS at 6, 12, and 24 hours by blinded assessors. Secondary outcomes included rescue-analgesic use within 24 hours, lochia pad count, perineal wound events (hematoma, dehiscence, infection), adverse events and length of hospital stay. Results: Mean NRS pain scores at 6, 12, and 24 hours were not different between groups: mean difference -0.11 (95% confidence interval (CI) -0.5, 0.28), -0.21 (-0.56, 0.15), and -0.21 (-0.51, 0.10), respectively. Rescue-analgesic use was similar in both groups (46.7% vs 56.5%; relative risk (RR) 0.83, 95% CI 0.62, 1.10). No drug-related adverse events or maternal complications were observed. The lidocaine group had a significantly higher lochia pad count (p < 0.001), whereas the length of hospital stay was significantly shorter than in the placebo group (p = 0.019). Conclusion: Topical 2% lidocaine gel did not provide a statistically significant reduction in post-episiotomy perineal pain during the first 24 hours compared with placebo. Therefore, it should not be recommended as a first-line analgesic in this setting.