British Journul of Obstetrics and Gynuecology May 1991, Vol. 98, pp. 476478
ADONIS 0306545691001ION
The use of Histoacryl for episiotomy repair AMIRAM ADONI,
EYAL ANTEBY
Summary. Histoacryl-tissue adhcsive (B. Braun Melsungen AG W. Germany) was used in place of skin sutures (2/0 chromic catgut, Ethicon Ltd, Edinburgh, Scotland) for episiotomy rcpair in a group of 20 women. This group was compared with two groups of women undergoing first and repeat episiotomy. Variables analysed included pain in the episiotomy site, pain while walking, sitting, sleeping, lying down, breast-feeding, micturating and defaecating. The Histoacryl group was superior with regard to all the variables. This simple, new method can reduce pain and inconvenience for patients, especially following the first delivery.
Thackcr & Banta (1Y83) stated that pain following cpisiotomy appears to be almost universal, especially during walking and sitting. There is an extensive literature on the testing of thcrapies and different techniques to prevent pain. Therapies that have been uscd include enzymes, systemic pain medications. antiinflammatory agcnts, local treatments such as local anaesthetics, gels and ointmcnts, alternative methods of rcpair and alternative suturing materials (Grant 1989; Mahomed etal. 1989; Isagcr-Sally et al. 1986). The purpose of this study was to determine whether Histoacryl-tissue adhcsivc (monomeric n-butyl-2-cyanoacry1, B. Braun), applicd to the skin in placc of stitches, can reduce the pain and discomfort originating at thc mediolatcral episiotomy site during the coursc of everyday activities. Subjects and methods Therc arc about 300 dclivcries per month at the Hadassah University hospital, Jcrusalem. The incidcnce of first and rcpcat episiotomy is 17% Department of Obstetrics and Gynecology, Hadassah University Hospital, Mt. Scopus, Jerusalem 91240, Israel
A. ADONI E. ANTEBY Correspondcncc: Dr A. Adoni
476
and 10'%, respectivcly. All episiotomies arc mediolateral, and thc size is usually no morc than 6 cm. Usually, repairs are performed by the junior physician in the delivcry room. In this study, only two of our staff physicians repaired the episiotomies using Histoacryl, or the traditional method. Sixty womcn, divided into three equal groups, participatcd in the study. Group 1 comprised patients undcrgoing first episiotomy repaired by continuous O()-chromic catgut in the vagina. continuous stitches of thc same material in the muscle, fascia1 layer and thc skin. The stitches were not removed. Group 2 compriscd patients undcrgoing repeat episiotomy, utilizing thc above technique and group 3 comprised patients undergoing a first episiotomy utilizing the same tcchnique as group 1 , but using Histoacryl instead o f stitches for the skin. A thin layer of tissue adhesive was applicd to the dry and exactly apposcd skin. Groups 1 and 3 (first episiotomy repair) wcrc selected randomly, by registration number; group 1 odd and group 3 even numbers. An explanation of the new mcthod was given to thc patients in group 3, all of whom agrccd vcrbally to the repair using Histoacryl. Thc degree of pain or discomfort was scored by a nurse, on thc sccond postpartum day according to verbal responses on an ordinal scale ranging from 1 to 5 (one was the minimum and five the maximum). The nurse knew only that
Histoacryl for episiotomy repair the patients had undergone episiotomy hut knew nothing about the method of repair or whether it was first or repeat episiotomy, or whether the patient was included in the study group. The degree of reported pain at the episiotomy site, as well as pain and discomfort while walking, sitting, lying down, breast-feeding, sleeping and during micturition and defaecation were determined. Patients were also asked whethcr they needed analgesics or equipment designed to make sitting more comfortable. Statistical analysis was performed using the Mann-Whitney W e s t from the 'Crunch' statistical packagc version 3. Results
Statistically significant differences between groups 1 and 2 (first episiotomy and repeat episiotomy) were found in three variables: pain at the cpisiotomy site (mean score 3.3, vs 2.6, U = 107, P
ADONIS 0306545691001ION
The use of Histoacryl for episiotomy repair AMIRAM ADONI,
EYAL ANTEBY
Summary. Histoacryl-tissue adhcsive (B. Braun Melsungen AG W. Germany) was used in place of skin sutures (2/0 chromic catgut, Ethicon Ltd, Edinburgh, Scotland) for episiotomy rcpair in a group of 20 women. This group was compared with two groups of women undergoing first and repeat episiotomy. Variables analysed included pain in the episiotomy site, pain while walking, sitting, sleeping, lying down, breast-feeding, micturating and defaecating. The Histoacryl group was superior with regard to all the variables. This simple, new method can reduce pain and inconvenience for patients, especially following the first delivery.
Thackcr & Banta (1Y83) stated that pain following cpisiotomy appears to be almost universal, especially during walking and sitting. There is an extensive literature on the testing of thcrapies and different techniques to prevent pain. Therapies that have been uscd include enzymes, systemic pain medications. antiinflammatory agcnts, local treatments such as local anaesthetics, gels and ointmcnts, alternative methods of rcpair and alternative suturing materials (Grant 1989; Mahomed etal. 1989; Isagcr-Sally et al. 1986). The purpose of this study was to determine whether Histoacryl-tissue adhcsivc (monomeric n-butyl-2-cyanoacry1, B. Braun), applicd to the skin in placc of stitches, can reduce the pain and discomfort originating at thc mediolatcral episiotomy site during the coursc of everyday activities. Subjects and methods Therc arc about 300 dclivcries per month at the Hadassah University hospital, Jcrusalem. The incidcnce of first and rcpcat episiotomy is 17% Department of Obstetrics and Gynecology, Hadassah University Hospital, Mt. Scopus, Jerusalem 91240, Israel
A. ADONI E. ANTEBY Correspondcncc: Dr A. Adoni
476
and 10'%, respectivcly. All episiotomies arc mediolateral, and thc size is usually no morc than 6 cm. Usually, repairs are performed by the junior physician in the delivcry room. In this study, only two of our staff physicians repaired the episiotomies using Histoacryl, or the traditional method. Sixty womcn, divided into three equal groups, participatcd in the study. Group 1 comprised patients undcrgoing first episiotomy repaired by continuous O()-chromic catgut in the vagina. continuous stitches of thc same material in the muscle, fascia1 layer and thc skin. The stitches were not removed. Group 2 compriscd patients undcrgoing repeat episiotomy, utilizing thc above technique and group 3 comprised patients undergoing a first episiotomy utilizing the same tcchnique as group 1 , but using Histoacryl instead o f stitches for the skin. A thin layer of tissue adhesive was applicd to the dry and exactly apposcd skin. Groups 1 and 3 (first episiotomy repair) wcrc selected randomly, by registration number; group 1 odd and group 3 even numbers. An explanation of the new mcthod was given to thc patients in group 3, all of whom agrccd vcrbally to the repair using Histoacryl. Thc degree of pain or discomfort was scored by a nurse, on thc sccond postpartum day according to verbal responses on an ordinal scale ranging from 1 to 5 (one was the minimum and five the maximum). The nurse knew only that
Histoacryl for episiotomy repair the patients had undergone episiotomy hut knew nothing about the method of repair or whether it was first or repeat episiotomy, or whether the patient was included in the study group. The degree of reported pain at the episiotomy site, as well as pain and discomfort while walking, sitting, lying down, breast-feeding, sleeping and during micturition and defaecation were determined. Patients were also asked whethcr they needed analgesics or equipment designed to make sitting more comfortable. Statistical analysis was performed using the Mann-Whitney W e s t from the 'Crunch' statistical packagc version 3. Results
Statistically significant differences between groups 1 and 2 (first episiotomy and repeat episiotomy) were found in three variables: pain at the cpisiotomy site (mean score 3.3, vs 2.6, U = 107, P
