Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial

Background: Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy. Aims: To evaluate if a 10 min ice-pack application relieved postpartum perineal pain and if the analgesic effect was maintained for up to 2 h. Methods: A randomised controlled trial conducted from December 2012 to February 2013 with 69 primiparous women ≥18 years old, 6–24 h postpartum, with perineal pain ≥ 3, who had not received anti-inflammatory medication or analgesics after childbirth, who were randomised to a single ice-pack application on the perineum for 10 min or standard care. The primary and secondary outcomes were a reduction ≥ 30% in perineal pain intensity, immediately after the application and the maintenance of the analgesic effect for up to 2 h, respectively. Findings: Immediately post-intervention, the proportion of women whose perineal pain decreased ≥ 30%was significantly higher in the experimental group. Within 2 h, there was no significant difference in the pain levels in both groups. Within 2 h, for 61.9% and 89.3% of women in the experimental and control group, respectively, the perineal pain levels remained unchanged. For the remaining participants, perineal pain was increasing after an average time of 1 h 45 min and 1 h 56 min for the experimental and control groups, respectively. Conclusion: By applying an ice-pack for 10 min to the perineum, effective pain relief is achieved, that is maintained for between 1 h 45 min and 2 h. Refereed/Peer-reviewed