One of a convincing meta-analysis explaining that lidocaine-prilocaine cream gives comparable results in reducing pain during perineal repair after vaginal delivery was published in 'The Journal of Maternal-Fetal & Neonatal Medicine'.

Perineal trauma is a common problem that affects women during vaginal delivery which can either be spontaneous (tear) or intentional (episiotomy). Suitable analgesics provide relief when the repair of perineal trauma is required. Amongst these, topical products such as lidocaine-prilocaine cream found effective in relieving pain, but still, there were unanswered questions regarding its efficacy and safety. This review was focused on examining the evidence of utilising lidocaine-prilocaine cream in comparison to local perineal infiltration anaesthesia for pain control during perineal repair after vaginal delivery. For this review, an electronic database were searched in Medline, Embase, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and the Cochrane Library from January 2006 to May 2018. All randomised controlled trials estimating the effect of lidocaine-prilocaine cream versus local infiltration anaesthesia in relieving pain during repair of perineal trauma were reviewed for this meta-analysis. Out of 15 studies, 4 studies were considered for this review. All studies had quality and risk of bias assessment.

Two researchers extracted data independently from the individual articles and entered into RevMan software. A weighted mean difference (WMD) and 95% confidence interval (CI) was computed. Higgins chi-square and (I2) statistics were used to assess the statistical heterogeneity between studies. In the case of significant heterogeneity, a random-effects model was used for meta-analysis. If not so, a fixed-effect meta-analysis was used in case of no significant heterogeneity. The pooled analysis of result in "pain score" was insignificant between the two groups (WMD -1.11; 95% CI (-2.55 to 0.33); p = 0.13). Also,  the use of additional analgesia portrayed no statistically significant difference between the two groups (WMD 1.34; 95% CI (0.66-2.71), p = 0.42). All in all, the three studies showed significant results favouring EMLA cream group users (WMD 4.65; 95% CI (1.96-11.03), p = 0.0005). There was the significantly shorter duration of repair in EMLA cream users (n = 92) than local infiltration anaesthesia (n = 95) (1.72 min; 95% CI (-2.76 to -0.67), p = 0.001) according to the pooled analysis of the outcome "duration of repair".