Background: Episiotomy is performed in almost all spontaneous vaginal deliveries in Thailand. It is known to cause moderate postpartum pain which has a negative effect on maternal quality of life. Lidocaine is used for relieving pain during the suturing. Local anesthesia and NSAIDs such as ketorolac, are often used in many pain relieving procedures with positive results. The purpose of this study is to investigate the pain reducing efficacy of combination of ketorolac and lidocaine during episiotomy comparing with lidocaine alone.
Materials and Methods: Two hundred and forty healthy singleton parturients who had undergone spontaneous vaginal delivery at the delivery room of Thammasat University Hospital were recruited. Participants were randomly assigned into two groups using systemic random sampling. The allocation was assigned in sealed envelopes. First half is ketorolac group receiving 1% lidocaine with 0.3% ketorolac (10 ml consisted of 100 mg and 30 mg of lidocaine and ketorolac tromethamine, respectively). Lidocaine group received 1% lidocaine. Primary outcomes were pain score assessed immediately after birth 2, 6 and 24 hours postpartum by visual analog scale (VAS). Postpartum complications were evaluated for secondary outcome.
Results: No statistical differences in demographic data and clinical characteristics were found in both study and control groups. Mean VAS of the study group was statistically lower than that of the control group after perineal repair (3.32 vs. 4.43; p<0.001), 2 hours (3.08 vs. 4.08; p<0.001) and 6 hours postpartum (2.52 vs. 3.63; p<0.001), respectively. Four cases in each group had postpartum hemorrhage. No case underwent peripartum hysterectomy.
Conclusion: Infiltration of ketorolac with lidocaine on episiotomy wound significantly reduced pain after perineal repair, 2 hours and 6 hours postpartum compared with lidocaine alone. No significant differences in side effects and postpartum complication were reported in both groups.

Keywords: Ketorolac, Lidocaine, Episiotomy, Local infiltration analgesia