BACKGROUND AND PURPOSE:

• Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat postpartum pain but their safety and effectiveness have not be studied
• This study by Wuytack et al. (Cochrane Database Systematic Review, 2016) sought to establish the effectiveness of oral NSAIDs in relieving acute perineal pain in the early postpartum period

METHODS:

• Systematic Review and Meta-Analysis
  • 28 Randomized controlled trials (RCTs) were included
• Data on 4,181 non-breastfeeding women were analyzed
  • 2,642 received an NSAID
  • 1,539 received a placebo or paracetamol (acetaminophen)

RESULTS:

NSAID vs. Placebo

• More women on single dose NSAID compared to placebo achieved adequate pain relief at four hours (risk ratio 1.91, 95% CI 1.64 to 2.23; low-quality evidence)
  • These results were similar for adequate pain relief achieved at six hours
• Fewer women on single dose NSAID required additional analgesia at 4 hours (risk ratio 0.39, 95% CI 0.26 to 0.58; low-quality evidence)
  • These results were similar for adequate pain relief achieved at six hours
•  Fewer maternal adverse effects were reported in the placebo group than the treatment group, though not all studies reported adverse effects

NSAID vs. Paracetamol

• The NSAIDs were also more effective than paracetamol at providing pain relief at four hours (risk ratio 1.54, 95% CI 1.07 to 2.22)
  • However, this was not the case at six hours
• There were no additional analgesia requirement were seen between the two groups at four hours (risk ratio 0.55, 95% CI 0.27 to 1.13)
  • Women in the NSAID group were less likely to require additional analgesia at six hours (risk ratio 0.28, 95% CI 0.12 to 0.67)
• There were no differences in maternal adverse effects between the groups after six hours
• Different types and doses of NSAIDs did not vary in effectiveness

CONCLUSIONS:

• For women who sustained perineal trauma and who are not breastfeeding, NSAIDS provide better pain relief than placebo/paracetamol
• Fewer women who received NSAIDs required additional analgesia
• Due to lack of strong quality of evidence, the authors suggest that future studies are needed to address adverse outcomes and the effect on breastfeeding

Learn More – Primary Sources:

Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period

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