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.