he Systematic Analyze Them in Terms The Nonpharmacological Methods Used in The Treatment of Perineal Pain After Episiotomy

Yıl 2020, Cilt: 9 Sayı: 2, 195 - 208, 30.06.2020

Nilüfer Tok Yanık Gül Ertem

https://doi.org/10.37989/gumussagbil.487004

Cited By: 2

Öz

Episiotomy
is an incision, it is used for to ensure the safe delivery of the baby, to
maintain perineal tonus and to prevent unwanted tears. Perineal
pain is adversely affects daily activities such as movement, urination,
defecation and breastfeeding especially in during the first 3 days postpartum. Therefore pain resulting from episiotomy should be
treated. In recent years, non-pharmacological methods are
effective in reducing the pain alone or together. The main objective is
to improve the quality of life by reducing the rate of analgesic use in the
treatment of pain. It has been reached 17
studies from these studies specifically examining the effects of non-pharmacological
methods between 2007- 2017. Cold
gel pad and ice pack application, low frequency Transkütan Electrical Nerve
Stimulation (TENS)
and high frequency TENS, Wrist-ankle acupuncture application, lavender-timol added washing solution,
cinnamon ointment and horse-tail ointment is effective, low dose laser therapy
(LLLT), ear acupuncture was found to be ineffective for the removal of perineal
pain after episiotomy. The sitz bath with lavender oil prepared has been found
to be effective in a study and not effective in the other study. It is
recommended that to investigation of at the level of evidence about the most
effective methods, advising advising health professionals about the use of
methods.

Anahtar Kelimeler

Episiotomy, Perineal Pain, Nonpharmacological Methods

Epizyotomi Sonrası Perineal Ağrının Tedavisinde Kullanılan Nonfarmokolojik Yöntemlerin Sistematik Açıdan İncelenmesi

Öz

Epizyotomi, bebeğin güvenli
doğumunu sağlamak, perine tonüsünü korumak ve istenmeyen yırtıkları ön­lemek
amacıyla yapılan insizyondur. Perineal ağrı, özellikle postpartum ilk 3 gün
boyunca, hareket etme, idrar yapma ve defekasyon, emzirme gibi günlük akti­viteleri
olumsuz etkilemektedir. Bu nedenle epizyotomiden kaynaklanan ağrı tedavi
edilmelidir. Son yıllarda farmakolojik olmayan yöntemler ya tek
başlarına ya da birlikte ağrıyı azaltmada etkili olmaktadırlar. Temel amaç ağrı
tedavisinde analjezik kulla-nım oranını azaltarak yaşam kalitesini
yükseltmektir. Bu çalışmalardan 2007- 2017 arasında olan özellikle non-farmakolojik yöntemlerin
etkilerini inceleyen 17 çalışmaya ulaşılmıştır. Epizyotomi sonrası perineal ağrının giderilmesinde soğuk
jel pedi ve buz paketi uygulamasının, düşük frekanslı Transkutan Elektriksel Sinir Stimülasyonu (TENS) ve yüksek fre­kanslı
TENS’in, bilek-ayak akapunktur
uygulaması­nın, lavanta-timolü ilave edilerek hazırlanan yıkama solüsyonunun,
tarçın
merhemi ve at-kuyruğu merhe­minin etkili olduğu, Düşük Doz Lazer Tedavisi (DDLT)’nin,
kulak akapunktur uygulamasının etkili olmadığı saptanmıştır. Lavanta yağı ile hazırlanan oturma banyosunun bir çalışmada
etkili olduğu sapta­nırken diğer çalışmada etkili olmadığı saptanmıştır.
Epizyotomi sonrası perineal ağrının giderilmesinde en etkili yöntemlerin kanıt
düzeyinde araştırılması, bu yöntemlerin kullanımı ile ilgili sağlık çalışanlarına
danışmanlık yapılması önerilmektedir. 

Anahtar Kelimeler

Epizyotomi, Perineal Ağrı, Nonfarmakolojik Yöntemler

Kaynakça

• 1. Yılmaz, S.D., Vural, G., & Bodur, S., (2010). Epizyotomi Bakımında Serum Fizyolojik ve Rivanolün İyileşme Sürecine Etkisi. Trakya Üniversitesi Tıp Fak Dergisi, 27(2), 172-177.
• 2. Durmaz, A., Buğdayci, R., (2013). Epizyotomi İyileşmesini Etkileyen Faktörler. Turkish Journal of Public Health, 11(2), 72-85.
• 3. Carroli, G., Mignini, L., (2009). Episiotomy for Vaginal Birth. Cochrane Database Of Systematic Reviews, 1(3).
• 4. Dönmez S., Sevil Ü., (2009). Rutin Epizyotomi Uygulanmasının Gerekliliği. Maltepe Üniversitesi Hemşirelik Bilim ve Sanatı Dergisi, 2(3), 105-112.
• 5. Declercq, E., Cunningham, D. K., Johnson, C., & Sakala, C.(2008). Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: Results of a national survey. Birth, 35, 16–24.
• 6. Macarthur, A. J., Macarthur, C. (2004). Incidence, severity, and determinants of perineal pain after vaginal delivery: A prospective cohort study. American Journal of Obstetrics and Gynecology, 191, 1199–1204.
• 7. Sapmaz, E., Altungül A.Ç., (2012). Sağ Medyolateral Epizyotomi Vakalarında Ağrı Kesici Olarak Tenoksikam ile Parasetamolün Karşılaştırılması. Fırat Tıp Dergisi, 17(2), 76-79.
• 8. Santos, J.O., Oliveira, S.M.J.V., Nobre, M.R.C., Aranha, A.C.C., Alvarenga, M.B., (2012 a). A Randomised Clinical Trial of The Effect of Low-Level Laser Therapy for Perineal Pain and Healing after Episiotomy: A Pilot Study. Midwifery, 28, 653–659.
• 9. Ak, Ö.B. Vaginal Doğum Yapan Kadınlarda Postpartum Perineal Ağrının Değerlendirilmesi. (2013). Sağlık Bilimleri Enstitüsü, Kadın Sağlığı ve Hastalıkları Hemşireliği Anabilim Dalı, Yüksek Lisans Tezi, İstanbul Üniversitesi
• 10. Özveren, H., (2011). Ağrı Kontrolünde Farmakolojik Olmayan Yöntemler. Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Hemşirelik Dergisi, 83-92.
• 11. Korkut Bayındır, S., Çürük, G. N. (2015). Türkiye’de Ağrıya Yönelik Tamamlayıcı ve Alternatif Tıp Uygulamaları Konusundaki Hemşirelik Tezlerinin İncelenmesi. Hemşirelikte Eğitim ve Araştırma Dergisi;12 (3), 162-169
• 12. George, S. (2013). A Comparatıve Study to Assess The Effectıveness of Sıtz Bath Versus Infrared Lamp Therapy on Epısıotomy Paın and Wound Healıng Among Postnatal Mothers at Selected Hospıtal, Bangalore. In Partial Fulfillment of Requirement For The Degree of Master of Science in Nursing, Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore
• 13. Karaçam, Z., (2013). Sistematik Derleme Metodolojisi: Sistematik Derleme Hazırlamak İçin Bir Rehber. Dokuz Eylül Üniversitesi Hemşirelik Yüksekokulu Elektronik Dergisi, 6 (1), 26-33.
• 14. Yusamran, C., Titapant, V., Kongjeera, A., (2007). Relief Perineal Pain After Perineorrhaphy by Cold Gel Pack Pad: A Randomized Controlled Trial. Thai Journal of Nursing Research, 11(2), 87-95.
• 15. Mahishale, A., Chougala, A., Patted, S., (2013). Effect of Therapeutic Ultrasound and Maternal Cooling Gel Pad for Perineal Pain Following Vaginal Delivery With Episiotomy. J Women’s Health Care, 2(128), 2167-0420.
• 16. Navvabi, S., Abedian, Z., Steen-Greaves, M., (2009). Effectivness of Cooling Gel Pads and Ice Packs on Perineal Pain. Brıtısh Journal Of Mıdwıfery, 17(11), 724-729.
• 17. UNFPA 2011 Annual Report. Delivering Results in a World of 7 Bilion http://www.unfpa.org/publications/unfpa-annual-report-2011 Erişim Tarihi: 17. 06. 2015
• 18. Pitangui, A.C.R., Sousa, L., Gomes, F.A., Ferreira, C.H.J., Nakano, A.M.S., (2012). High-Frequency Tens in Post-Episiotomy Pain Relief in Primiparous Puerpere: A Randomized, Controlled Trial. J. Obstet. Gynaecol. Res, 38(7), 980–987.
• 19. Zafar, S., (2008). Comparison of A Single-Knot Versus Three Layered Technique of Perineal Repair After Vaginal Delivery in Women Requiring Episiotomy: A Double Blind Randomized Controlled Trial. Turkish German Gynecol Assoc, 9(3), 129-33.
• 20. Kartal, B., Özhan, T., Cırık M., (2014). Primipar Kadınların Epizyotomi Bakımına İlişkin Uygulamaları. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 3(4) 1056-1066.
• 21. Kalis, V., Landsmanova, J., Bednarova, B., Karbanova, J., Laine, K., Rokyta, Z. (2011). Evaluation of The İncision Angle of Mediolateral Episiotomy at 60 Degrees. International Journal of Gynecology and Obstetrics, 112 (2011) 220-224
• 22. Rasouli, M., Keramat, A., Khosravi, A., & Mohabatpour, Z. (2016). Prevalence and factors associated with episiotomy in Shahroud City, northeast of Iran. Int J Womens Health Reprod Sci, 4(3), 125-129.
• 23. Karbanova, J., Rusavy, Z., Betincova, L., Jansova, M., Necesalova, P., & Kalis, V. (2014). Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy. International Journal of Gynecology & Obstetrics, 127(2), 152-156.
• 24. Karaçam, Z., Eroğlu, K., (2003). Effects of Episiotomy on Bonding and Mother's Health. Journal of Advanced Nursing, 43(4), 384-94.
• 25. Sayiner, F.D., Demirci, N. (2007). Prenatal Perineal Masajın Vaginal Doğumlarda Etkinliği. İÜFN Hemşirelik Dergisi; 15(60)146-154.
• 26. Althabe, F., Belizan, J.M., Bergel, E. (2002). Episiotomy Rates in Primiparous Women in Latin America: Hospital Based Descriptive Study. Bmj.20, 324 (7343), 945-6.
• 27. Çiftpinar, T., Yörük, P., Dündar, Ö., Tütüncü, L., Müngen, E., Yergök, Y.Z. (2009). Epizyotomi Onarımı Zamanının Postpartum Kan Belirteçlerine Etkisi. Trakya Üniversitesi Tıp Fakültesi Dergisi, 26(3), 203-207.
• 28. Schoon, P.G. (2001). Episiotomy: yea or nay. Obstet Gynecol Surv; 56, 667-9.
• 29. Sartore, A., De Seta, F., Maso, G., Pregazzi, R., Grimaldi, E., Guaschino, S. (2004). The Effects of Mediolateral Episiotomy on Pelvic Floor Function After Vaginal Delivery. Obstet. Gynecol. 103(4), 669-73.
• 30. Fodstad, K., Staff, A.C., Laine, K. (2014). Effect of Different Episiotomy Techniques on Perineal Pain and Sexual Activity 3 Months After Delivery. Int. Urogynecol J. 25,1629–1637.
• 31. Çöçelli, L.P., Bacaksiz, B.D., Ovayolu, N. (2008). Ağrı Tedavisinde Hemşirenin Rolü. Gaziantep Tıp Dergisi, 14, 53-58.
• 32. Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American journal of sports medicine, 32(1), 251-261.
• 33. Steen, M., Briggs, M., King, D. (2006). Alleviating postnatal perineal trauma: To cool or not to cool?. British Journal of Midwifwry, 14(5), 304-308.
• 34. Hasegawa, J., Leventhal, L. C. (2009). Pharmacological and non pharmacological treatmente for relief of perineal pain after vaginal delivery. Einstein (São Paulo), 7(2), 194-200.
• 35. Leventhal, L.C., de Oliveira, S.M.J.V., Nobre, M.R.C., da Silva, F.M.B. (2011). Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial. The Journal of Midwifery & Women’s Health, 56(2), 141-146.
• 36. Oliveira, S., Silva, F., Riesco, M., Rosario, M., Nobre, M. (2012). Comparison of Application Times for Ice Packs used to Relieve Perineal Pain after Normal Birth: A Randomised Clinical Trial. Journal Of Clinical Nursing, 21, 3382–3391.
• 37. Mahishale, A., Chougala, A., & Patted, S. (2013). Effect of therapeutic ultrasound and maternal cooling gel pad for perineal pain following vaginal delivery with episiotomy. J Women’s Health Care, 2(3), 1-4.
• 38. Paiva, C.D.S.B., de Oliveria, S.M.J.V., Francisco, A.A., da Silva, R.L., Mendes, E.D.P.B., Steen, M. (2016). Length of perineal pain relief after ice pack application: A quasi-experimental study. Women and Birth, 29(2), 117-122
• 39. Beleza, A.C.S., Ferreira, C.H.J., Driusso, P., dos Santos, C.B., Nakano, A.M.S. (2017). Effect of cryotherapy on relief of perineal pain after vaginal childbirth with episiotomy: a randomized and controlled clinical trial. Physiotherapy, 103(4), 453-458
• 40. Abedian, Z., Navabi Rigi, S. D., Dadgar, S., & Esmaili, H. (2007). Comparing the Effect of Colling Gel Pads and Ice Pack, after Episiotomy, on the Intensity od Perinal Pain. The Iranian Journal of Obstetrics, Gynecology and Infertility, 10(2), 79-86.
• 41. Steen, M., & Marchant, P. (2007). Ice packs and cooling gel pads versus no localised treatment for relief of perineal pain: a randomised controlled trial. Evidence-Based Midwifery, 5(1), 16-23.
• 42. Lu, Y. Y., Su, M. L., Gau, M. L., Lin, K. C., & Au, H. K. (2015). The efficacy of cold-gel packing for relieving episiotomy pain–a quasi-randomised control trial. Contemporary nurse, 50(1), 26-35.
• 43. Jahdi, F., Sheikhan F., Haghani, H. (2010). The effect of cooling gel pad on the intensity of perineal pain following episiotomy. Arak Medical University Journal, 13(3), 76-83.
• 44. Senol, D.K., Aslan, E. (2017). The Effects of Cold Application to the Perineum on Pain Relief After Vaginal Birth. Asian Nursing Research, 11(4), 276-282
• 45. Kömürcü, N., Ergin, A.B., Çalişkan, E., Buckley, S.J., Çalik, K.Y., Çoker, H., Karabekir, N. (2013). Doğum Ağrısının Kontrolünde Non- Farmakolojik Yöntemler. İçinde N. Kömürcü (Ed.). Doğum Ağrısı Ve Yönetimi. İstanbul: Nobel Tıp Kitapevleri, 63-178.
• 46. Lamina, S., Shmaila, H., Muhammed, S.A. (2008). Transcutaneous electrical nevre stimulation (TENS) in the symptomatic management of choronic prostatitis/chronic pelvic pain syndrome: a placebo-control randomized trial. İnternational braz j urol, 34(6), 708-714.
• 47. Pitangui, A.C., Araujo, R.C., Bezerra, M.J., Riberio, C.O., Nakano, A. (2014). Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial. Brazilian Journal of Physical Therapy, 18(1), 72-78.
• 48. Proctor, M., Farquhar, C., Stones, W., He, L., Zhu, X., Brown, J. (2010). Transcutaneous Electrical Nerve Stimulation for Primary Dysmenorrhoea. The Cochrane Library.
• 49. Santana, L.S., Gallo, R.B.S., Ferreira, C.H.J., Duarte, G., Quintana, S.M., Marcolin, A.C. (2016). Transcutaneous electrical nevre stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. Journal of Physiotherapy, 62(1), 29-34.
• 50. Son, S. J., Kim, H., Seeley, M. K., Feland, J. B., & Hopkins, J. T. (2016). Effects of transcutaneous electrical nerve stimulation on quadriceps function in individuals with experimental knee pain. Scandinavian journal of medicine & science in sports, 26(9), 1080-1090.
• 51. Cherian, J. J., Harrison, P. E., Benjamin, S. A., Bhave, A., Harwin, S. F., & Mont, M. A. (2016). Do the effects of transcutaneous electrical nerve stimulation on knee osteoarthritis pain and function last?. The journal of knee surgery, 29(06), 497-501.
• 52. Buko, H. Ş. (2013). Servikal Disk Hernisine Bağlı Akut Boyun Ağrısında Düşük Doz Lazer Tedavisinin Etkinliği. Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Tıpta Uzmanlık Tezi, Çukurova Üniversitesi, Adana
• 53. Doğan, G.E., Demir, T., Orbak, R., (2014). Periodontolojide Düşük Doz Lazer Uygulamaları. Marmara Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 4(1), 43-50
• 54. Burcu, B.A.Ş., Duran, H. (2012). Temporomandibular Eklem Bozukluklarının Tedavisinde Düşük Doz Lazer Uygulamasının Yeri. Ondokuz Mayıs Üniversitesi Diş Hekimliği Fakültesi Dergisi, 13(1).
• 55. Santos, J.O., Oliveira, S.M.J.V., Silva, F.M.D., Nobre, M.R.C., Osava, R.H., Riesco, M.L.G., (2012 b). Low-Level Laser Therapy for Pain Relief After Episiotomy: A Double-Blind Randomised Clinical Trial. Journal Of Clinical Nursing, 21(3513–3522)ç
• 56. Alvarenga, M.B., de Oliveria, S.M.J.V., Francisco, A.A., da Silva, F.M.B., Sousa, M., Nobre, M.R. (2017). Effect of low-level laser therapy on pain and perinal healing after episiotomy: A triple-blind randomized controlled trial. Lasers in surgery and medicine, 49(2), 181-188.
• 57. Al-Shaikh, S. F. (2011). The Evaluation of Low Level Laser Therapy Using the Diode Laser in Enhancement of Episiotomy Wound Healing. Medical Journal of Babylon, 8(2), 213-220.
• 58. Enwemeka, C.S., Parker, J.C., Dowdy, D.S., Harkness, E.E., Harkness, L.E., Woodruff, L.D. (2004). The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomedicine and Laser Therapy, 22(4), 323-329.
• 59. Bjordal, J.M., Johnson, M.I., Iversen, V., Aimbire, F., Lopes-Martins, R.A.B. (2006). Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomedicine and Laser Therapy,24(2), 158-168
• 60. Chow, R.T., Johnson, M.I., Lopes-Martins, R.A., Bjordal, J.M. (2009). Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. The Lancet, 374(9705), 1897-1908.
• 61. Kelly, R.B. (2009). Acupuncture for pain. American family physician, 80(5).
• 62. Yilar, Z. (2014). Ayak Refleksolojisinin Doğum Ağrısına ve Doğum Eyleminin Süresine Etkisi. Sağlık Bilimleri Enstitüsü Doğum, Kadın Sağlığı ve Hastalıkları Hemşireliği Anabilim Dalı, Doktora Tezi, Atatürk Üniversitesi, Erzurum
• 63. Skilnand, E., Fossen, D., Heiberg, E. (2002). Acupuncture in the management of pain in labor. Acta obstetricia et gynecologica Scandinavica, 81(10), 943-948.
• 64. Kindberg, S., Klünder, L., Strøm, J., Henriksen, T. B., (2009). Ear Acupuncture or Local Anaesthetics as Pain Relief During Postpartum Surgical Repair: A Randomized Controlled Trial. Bjog: An International Journal Of Obstetrics & Gynaecology, 116(4), 569-576.
• 65. Marra, C., Pozzi, I., Ceppi, L., Sicuri, M., Veneziano, F., Regalia A.L. (2011). Wrist–Ankle Acupuncture as Perineal Pain Relief After Mediolateral Episiotomy:A Pilot Study. The Journal Of Alternatıve And Complementary Medıcıne, 17(3), 239-241.
• 66. Usichenko, T.I., Dinse, M., Hermsen, M., Witstruck, T., Pavlovic, D., Lehmann, C. (2005). Auricular acupuncture for pain relief after total hip arthroplasty-a randomized controlled study. Pain, 114(3), 320-327.
• 67. Chen, Y., Tian, S., Tian, J., Shu, S. (2017). Wrist-ankle acupuncture (WAA) for primary dysmenorrhea (PD) of young females: study protocol for a randomized controlled trial. BMC complementary and alternative medicine, 17(1), 421
• 68. Zhu, L.B., Chan, W.C., Lo, K.C., Yum, T.P., Li, L. (2014). Wrist-ankle acupuncture fort he treatment of pain symptoms: a systematic review and meta-analysis. Evidence-Based Complementary and Medicine, 2014
• 69. Şar, S., Kahya, E., Ataç, A. (2011). History of Aromatherapy and Some Examples of Medicinal Plants Used in This Area- Aromaterapinin Tarihçesi ve Bu Alanda Kullanılan Tıbbi Bitkilerden Örnekler. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi, 32-33.
• 70. Bingöl, F.N., Akbulut, G., (2012). Tip 2 Diabetes Mellitus Ve Tarçın. Bozok Tıp Dergisi, 3(39-46).
• 71. Vakilian, K., Atarha, M., Bekhradi, R., Chaman, R. (2011). Healing advantages of lavender essential oil during episiotomy recovery: a clinical trial. Complementary therapies in clinical practice, 17(1), 50-53.
• 72. Sheikhan, F., Jahdi, F., Khoei, E.M., Shamsalizadeh, N., Sheikhan, M., Haghani, H., (2012). Episiotomy Pain Relief: Use of Lavender Oil Essence in Primiparous Iranian Women. Complementary Therapies in Clinical Practice, 18(66-70).
• 73. Marzouk, T., Barakat, R., Ragab, A., Badria, F., Badawy, A. (2015). Lavender-thymol as a new topical aromatherapy preparation for episiotomy: a randomised clinical trial. Journal of Obstetrics and Gynaecology, 35(5), 472-475
• 74. Karabulut, H. (2014). Doğum Eyleminde Aromaterapinin Etkileri. Sağlık Bilimleri Enstitüsü Kadın Sağlığı Ve Hastalıkları Hemşireliği Anabilim Dalı, Yüksek Lisans Tezi, T.C. İstanbul Üniversitesi, İstanbul
• 75. Masoumi, Z., Keramat, A., Hajiaghaee, R. (2011). Systematic review on effect of herbal medicine on pain after perineal episiotomy and cesarean cutting. Journal of Medicinal Plants, 10(40), 1-16.
• 76. Olapour, A., Behaeen, K., Akhondzahed, R., Soltani, F., al Sadat Razavi, F., Bekhradi, R. (2013). The effect of inhalation of aromatherapy blend containing lavender essential oil on cesarean postoperative pain. Anesthesiology and pain medicine, 3(1), 203.
• 77. Chhretri, H.P., Yogol, N.S., Sherchan, J., Anupa, K.C., Mansoor, S., Thapa, P. (2010). Formulation and evaluation of antimicrobial herbal ointment. Kathmandu University Journal of Science, Engineering and Technology, 6(1), 102-107.
• 78. Bedi, M.K., Shenefelt, P.D. (2002). Herbal therapy in dermatology. Archives of dermatology, 138(2), 232-242.
• 79. Mohammadi, A., Mohammad-Alizadeh-Charandabi, S., Mirghafourvand, M., Javadzadeh, Y., Fardiazar, Z., Effati-Daryani, F., (2014). Effects of Cinnamon on Perineal Pain and Healing of Episiotomy: A Randomized Placebo-Controlled Trial. Journal Of Integrative Medicine, 12(4), 359-366.
• 80. Asgharikhatooni, A., Bani, S., Hasanpoor, S., Alizade, S.M., Javadzadeh, Y. (2015). The effect of equisetum arvense (horse tail) ointment on wound healing and pain intensity after episiotomy: a randomized placebo-controlled trial. İrenian Red Crescent Medical Journal, 17(3).
• 81. Khadivzadeh, T., Molkizadeh, M., Rakhshandeh, M. (2009). P302 Evaluation of lavander cream effect on episiotomy pain and wound healing in primiparous women International Journal of Gynecology & Obstetrics, 107(S2).
• 82. Aradmehr, M., Azhari, S., Ahmadi, S., Azmoude, E. (2017). The effect of chamomile cream on episiotomy pain primiparous women: a randomized clinical trial. Journal of caring sciences, 6(1), 19.
• 83. Shahrahmani, H., Kariman, N., Jannesari, S., Rafieian-Kopaei, M., Mirzaei, M., Ghalandari, S., Mardani, G. (2018). The effect of gren tea ointment on episiotomy pain and wound healing in primiparous women: A randomized, double-blind, placebo-controlled clinical trial. Phytotherapy Research, 32(3), 522-530.
• 84. Hajhashemi, M., Ghanbari, Z., Movahedi, M., Rafieian, M., Keivani, A., Haghollahi, F. (2018). The effect of Achillea millefolium and Hypericum perforatum ointments on episiotomy wound healing in primiparous women. The Journal of Maternal-Fetal & Neonatal Medicine, 31(1), 63-69.
• 85. Lavaf, M., Simbar, M., Mojab, F., Majd, H.A., Samimi, M. (2017). Comparison of honey and phenytoin (PHT) cream effects on intensity of pain and episiotomy wound healing in nulliparous women. Journal of Complementary and Integrative Medicine, 15(1).
• 86. Hasegawa, J., Leventhal, L.C., (2009). Pharmacological and Non-Pharmacological Treatment for Relief of Perineal Pain after Vaginal Delivery. Einstein (São Paulo), 7(2), 194-200.