Retrospective case review of combined local mepivacaine and steroid injections into vaginal trigger points for the management of moderate-to-severe perineal pain after childbirth

• Published in: Archives of gynecology and obstetrics 2019-02, Vol.299 (2), p.501-505
• Main Authors: Moya Esteban, Beatriz M., Solano Calvo, Juan A., Torres Morcillo, Celia, Delgado Espeja, Juan J., González Hinojosa, Jerónimo, Zapico Goñi, Álvaro
• Format: Article
• Language: English
• Subjects: Adult; Anesthetics, Local - pharmacology; Anesthetics, Local - therapeutic use; Childbirth & labor; Dyspareunia - diet therapy; Dyspareunia - etiology; Endocrinology; Fecal incontinence; Female; General Gynecology; Gynecology; Human Genetics; Humans; Local anesthesia; Medicine; Medicine & Public Health; Mepivacaine - pharmacology; Mepivacaine - therapeutic use; Obstetrics; Obstetrics/Perinatology/Midwifery; Pain; Pelvic Pain - drug therapy; Pelvic Pain - etiology; Pelvis; Perineum - injuries; Postpartum Period; Pregnancy; Retrospective Studies; Steroids - pharmacology; Steroids - therapeutic use; Vagina - drug effects; Womens health; Young Adult
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-018-5000-5

Objective After an obstetric trauma, a non-negligible number of postpartum women complain of perineal pain and dyspareunia. These symptoms clearly diminish their quality of life. Many treatment options have been suggested, such as oral analgesia, local anaesthetic, or steroid injections… Regretfully, none of these have yet demonstrated their efficacy with the validated trials. The objective of this review is to retrospectively evaluate the response to vaginal infiltrations into the trigger points (where the vaginal/perineal examination sets off the maximum intensity of pain) combining local anaesthetic and corticosteroids. Methods Our goal is to detect women who complain of sexual disfunction and perineal pain 2 and 6 months after childbirth. All reviewed cases correspond to vaginal deliveries made between June 2016 and April 2017. Trigger points were detected through a vaginal examination. Patients with moderate-to-severe perineal pain were determined using a visual analogue score (VAS 0–10). We suggested a treatment of vaginal infiltration specifically into the trigger points. Patients underwent local injections with a combination of mepivacaine hydrochloride 2% (8 ml) and betamethasone acetate (2 ml). Results Twenty-seven women were treated with vaginal injections directly into the trigger points. Seven of them [7/27 (25.92%)] were treated 2 months after delivery and experienced complete recovery of their perineal pain 4 months after the treatment. Those who first chose conservative treatment [20/27 (74.08%)] were also assessed 6 months after giving birth. This group continued to suffer the same symptoms and they then subsequently underwent vaginal injections. As well as the first group, these women experienced complete recovery of their perineal pain after treatment. No side effects have been registered so far. Conclusion Women treated with vaginal injection into the trigger points improved in a fast and effective way. It seems to be a well-tolerated and safe option for women with moderate-to-severe pain.