ORIGINAL RESEARCH – QUANTITATIVELength of perineal pain relief after ice pack application: A quasi-experimental study
Section snippets
Background
Following spontaneous vaginal birth, women can experience varying levels of perineal pain and there is evidence to suggest that the severity of the pain is linked to the severity of perineal injury.1 However, women with an intact perineum can also suffer from pain and discomfort.2 Postpartum perineal pain can commence in the first few hours after birth and may persist up to one year.3 In the early postnatal period, perineal pain can affect a woman's mobility and also her ability to perform
Literature review
A recent Cochrane systematic review14 analysed 10 randomised controlled trials comparing the effectiveness of local cooling treatments applied to the perineum with no treatment and other local and systemic treatments. The authors identified that ice packs are often applied for 10–20 min, and during this time period, a reduction in perineal temperature between 10 °C and 15 °C is considered ideal to achieve an analgesic effect.14, 15 However, there is no clear evidence to make a recommendation about
Method
A quasi-experimental study, using a pre and post-test design, with participants being their own control group. This study design was chosen because there is previous evidence from a blinded randomised, placebo controlled trial,12 about the effectiveness of ice pack applications in alleviating postpartum perineal pain. Therefore, in considering ethical implications, we decided to not deprive any participant of our study from an effective treatment.
This investigation was performed at the
Results
During data collection period 1219 women delivered vaginally in this maternity hospital, but only 44.8% were eligible for this study. Approximately 16% of the eligible women met the inclusion criteria; however, 5.9% of them declined to participate in this study. Four participants were excluded, two of them received analgesics in the follow-up period and two ceased participation before the intervention was completed. In total 50 women met all inclusion criteria and were recruited for the study.
Discussion
This research investigates the length of perineal pain relief after a single application of ice pack on multiparous women, to fill the gap in literature concerning the optimum time interval between multiple ice applications.
The findings would then assist in the writing and implementation of national guidelines for postnatal care. Therefore, this study aimed to evaluate the duration of the analgesic effect (up to 2 h) after a single application of ice pack to the perineum for 20 min.
The findings
Limitations
Because this study design consists of a single group, no random allocation sequence and no blind intervention were implemented. Additionally, a baseline measurement against a control group that remained completely untreated is lacking. Since these items are important to minimise bias, interpreting these results should be done with caution once the differences between the pre-test and the post-test cannot be fully related to the intervention.
Conclusion
This investigation supports the hypothesis that applying an ice pack for 20 min to the perineum region after spontaneous vaginal birth reduces perineal temperature to the recommended levels to achieve an analgesic effect, and thereby, alleviates perineal pain for up to 2 h even when the perineal temperature returns to baseline levels.
These findings confirm earlier studies that localised cooling can alleviate perineal pain safely and effectively.
This study specifically investigated multiparous
Funding statement
This research was funded by National Council for Scientific and Technological Development (478646/2012-7) (CNPq).
Conflicts of interest
There are no conflicts of interest to disclose.
Author contributions
All authors meet at least one of the following criteria (recommended by the ICMJE: http://www.icmje.org/ethical_1author.html) and have agreed on the final version: substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content.
Acknowledgments
To the Amparo Maternal for supporting this study. To the postpartum women who participated in this study.
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Cited by (16)
Cold compared with room temperature compress on the repaired primiparous perineum following injury at normal vaginal delivery: a randomized controlled trial
2024, American Journal of Obstetrics and Gynecology MFMEffect of Cold Therapy on Managing Postoperative Pain Following Breast Conserving Surgery
2023, Pain Management NursingThe Effect of Cold Therapy Applied to the Incision Area After Abdominal Surgery on Postoperative Pain and Analgesic Use
2021, Pain Management NursingCitation Excerpt :However, Shin et al. (2009) and Mahshidfar et al. (2016) concluded that cold therapy was cost-effective and an effective technique. Saeliw et al. (2010), Koc et al. (2006), Kuzu (1999), and Paiva et al. (2016) also found a decrease in pain intensity after cold therapy. The present study found no difference in pain level between the experimental and control groups at hour 1; however, in the experimental group, pain levels decreased after cold therapy application.
The effects of cryotherapy on perineal pain after childbirth: A systematic review and meta-analysis
2020, MidwiferyCitation Excerpt :Patients were nulliparous or multiparous and had term child birth with or without episiotomies. The types of cryotherapy varied, and included cold gel packs (Navvabi et al., 2009; Sheikhan et al., 2011; Steen et al., 2000; Steen and Marchant, 2007; Yusamran et al., 2007), ice packs (Beleza et al., 2017; Francisco et al., 2018; Gallie et al., 2003; Leventhal et al., 2011; Moore and James, 1989; Navvabi et al., 2009), frozen normal saline sachets (Beleza et al., 2017; de Souza Bosco Paiva et al., 2016; Steen et al., 2000; Steen and Marchant, 2007), and crushed ice in a latex glove (Morais et al., 2016). Six studies used cold gel packs or ice packs wrapped with sterile gauze or cotton tissue (Beleza et al., 2017; Francisco et al., 2018; Leventhal et al., 2011; Morais et al., 2016; Steen et al., 2000; Steen and Marchant, 2007; Yusamran et al., 2007), while the other studies did not mention these details.
Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial
2018, Women and BirthCitation Excerpt :Therefore, application of ice pack for 10 min might offer similar benefits as applications for 20 min. Concerning the duration of the analgesic effect, results demonstrate a slightly longer time period when compared to those obtained by applying an ice pack to the perineum for 20 min, which provided perineal analgesia from 1 h 35 min to up to 2 h.21 Thus, application of ice pack for 10 min can offer as many benefits as applications for 20 min with longer analgesic effect. Although, some women declined to participate in this investigation, most of those who consented to participate rated the treatment as being comfortable and were satisfied with this therapy as a method for alleviating pain.