The Effect of Co-treatment of Lidocaine and Epinephrine in Pain and Bleeding Intensity During and After Episiotomy in Primigravida Women: A Randomized Single-Blinded Clinical Trial

Background: Episiotomy is a highly painful obstetric procedure that causes noticeable bleeding and is commonly performed during normal vaginal delivery (NVD). Objectives: This study aimed to compare the effect of co-treatment with lidocaine and epinephrine in reducing bleeding and pain during and after episiotomy. Methods: This randomized, double-blinded clinical trial was conducted on 200 primigravida women admitted for NVD at Yas Hospital Complex, Tehran, Iran, in 2018. A simple randomization method was used to assign participants in a 1:1 ratio to the study groups. In both the intervention and control groups, 2 - 3 minutes before the episiotomy, 2% lidocaine hydrochloride (10 mg in 100 cc saline) was injected. In the intervention group, 1:200,000 units of epinephrine were added to the lidocaine ampoule. Study outcomes included pain intensity, measured using a Visual Analog Scale (VAS), and bleeding intensity, assessed by counting the number of completely blood-soaked gauzes used during and after the episiotomy. Data were analyzed using SPSS software version 24. The independent t-test or Mann–Whitney U test was used for quantitative variables, depending on data distribution. Crosstabs and Fisher’s exact test were applied as appropriate. A P-value of less than 0.05 was considered statistically significant. Results: Baseline variables were similar between the two groups. Pain intensity was significantly lower in the intervention group compared to the control group during (1.61 ± 1.49 vs. 1.95 ± 1.63; P = 0.029) and after (1.94 ± 1.04 vs. 2.46 ± 1.46; P = 0.007) episiotomy. Furthermore, the number of completely blood-soaked gauzes was significantly higher in the control group (6.59 ± 1.64 vs. 5.79 ± 1.40; P < 0.001). Conclusions: Although the analgesic effect of lidocaine is well known, our study demonstrated that co-treatment with epinephrine significantly enhances the analgesic effect and duration of lidocaine, while also reducing bleeding associated with episiotomy.