SCOTTSDALE, ARIZ. — Perineal repairs involving fast-absorbing polyglactin 910 sutures resulted in less pain and earlier resumption of sexual intercourse for new mothers in a randomized, controlled trial comparing the material with standard polyglactin 910 and chromic catgut.
Patients repaired with fast-absorbing polyglactin 910 sutures consumed fewer doses of analgesia and narcotics within 36–48 hours of giving birth. Two-thirds had resumed sexual intercourse at 6 weeks, and 48% had a pain-free experience, investigator Emmanuel Bujold, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.
Only 42% of women repaired with chromic catgut sutures and 56% with standard polyglactin 910 resumed intercourse at 6 weeks. Just 27% in the chromic catgut cohort and 42% in the standard polyglactin 910 group said intercourse was pain free.
“The benefits of fast-absorbing polyglactin 910 include less short-term perineal pain and probably a shorter time to resumption of pain-free sexual intercourse,” said Dr. Bujold of Ste. Justine Hospital and the University of Montreal.
Dr. Bujold and coinvestigator Nathalie Leroux, M.D., also of the University of Montreal, undertook the study to see if the fast-absorbing form of polyglactin 910 could offer the benefits of a synthetic suture without the problems associated with delayed absorption of sutures.
He described suture-related discomfort as very common, with 85% of women suffering some form of perineal trauma in spontaneous vaginal birth. Medical literature reports as many as 69% require sutures, according to the investigators. Most patients suffer perineal pain after delivery, and about a fifth have long-term problems.
The study enrolled women with uncomplicated pregnancies early in labor. Those who had an uncomplicated median episiotomy or a second-degree perineal tear were randomized to sutures made with the three materials: 66 to chromic catgut, 60 to standard polyglactin 910, and 66 to fast-absorbing polyglactin 910.
The well-balanced groups contained women 30 years old on average. More than half of the standard polyglactin 910 cohort and two-thirds of the other cohorts were nulliparous. More than 40% in each group required an episiotomy. About one in four had dyspareunia before pregnancy.
Investigators used a standard analgesia protocol: 50 mg of immediate-release indomethacin and 500 mg of naproxen every 12 hours for 24 hours. As-needed doses were standardized at 500 mg of naproxen every 12 hours, 30 mg of codeine plus 325 mg of acetaminophen, and 1 mg of hydromorphone.
Nurses doing postpartum pain assessments were blinded to the sutures used. Neither pain questionnaire nor visual analog scale scores showed significant differences in evaluation of perineal pain 36–48 hours after the women had given birth.
The median number of analgesic doses was seven with chromic catgut, eight with standard polyglactin 910, and six with fast-absorbing polyglactin 910. Narcotic doses averaged one with chromic catgut and two with standard polyglactin 910 but zero with fast-absorbing polyglactin 910.
At 6 weeks, the number of women for whom data were available had fallen to 53 of the women treated with chromic catgut, 43 with standard polyglactin 910, and 58 with fast-absorbing polyglactin 910.
The data on return to sexual intercourse and pain-free sexual intercourse were significant only when chromic catgut and fast-absorbing polyglactin 910 were compared. At 3 months postpartum, fast-absorbing polyglactin 910 still showed a slight advantage but it was not significant.
Stephen H. Cruikshank, M.D., of Wright State University in Dayton, Ohio, praised the investigators for “a simple but most effective study,” which received the association's Central Prize Award. Dr. Cruikshank, the association's new president, said, “It just goes to show us sometimes the most effective study is the simplest.”