Postpartum pain after vaginal delivery. A review of comparative analgesic trials

Perineal tissue injury and uterine cramping within the first 24-48 hours after vaginal delivery are established models for studying pain relief. In this study, information was gathered from prospective, randomized investigations comparing the safety and efficacy of several oral analgesics. Nonsteroidal antiinflammatory drugs (NSAIDs) have been found consistently to be more useful than a placebo or acetaminophen. As compared with aspirin, the newer NSAIDs had a more delayed onset of action but required fewer doses. Mild analgesics were usually all that was necessary, and a combination with codeine was usually unnecessary. Side effects and breast milk concentrations of the drugs were negligible for this short-term therapy. Although no drug was found to be preferable to the others, aspirin and ibuprofen were the least expensive.