Using topical lidocaine for pain relief during perineal suturing

Background/Aims Perineal trauma is a common consequence of vaginal birth, affecting up to 90% of first-time mothers. Effective pain management during perineal suturing is essential, but many women report inadequate pain relief. Traditional methods, such as local infiltration with lidocaine, can cause additional discomfort, while epidural analgesia is not always available or effective. The aim of this literature review was to evaluate the efficacy, safety, dosage and practical implementation of topical lidocaine. Methods A structured search was conducted across PubMed, Medline, Cochrane and CINAHL for papers published between 2004 and 2024, using key terms related to topical anaesthetics and perineal suturing. Data were extracted and synthesised narratively. Results Topical lidocaine provides significant pain relief comparable to infiltrative lidocaine, with fewer adverse effects and higher patient satisfaction. However, its use remains inconsistent as a result of variations in clinical practice and a lack of standardised guidelines. Conclusions Topical lidocaine is a practical, non-invasive option for analgesia during perineal suturing and can be used as an alternative or adjunct to infiltration, especially in cases where there is no epidural or inadequate epidural block. It may offer similar pain relief with greater acceptability for some women by avoiding needle pain. Evidence supports a generally favourable safety profile when used appropriately, but regimens vary across studies. Implications for practice Practice would benefit from local protocols on indications for use, dose limits, timing/contact time and documentation, as well as staff training to standardise use. Further work is needed to define an optimal regimen and assess outcomes in routine care.