Intended for healthcare professionals


Effectiveness and acceptability of lidocaine spray in reducing perineal pain during spontaneous vaginal delivery: randomised controlled trial

BMJ 2006; 333 doi: (Published 13 July 2006) Cite this as: BMJ 2006;333:117
  1. Julia Sanders, MRC HSR training fellow (julia.sanders{at},
  2. Rona Campbell, professor of health services research1,
  3. Tim J Peters, professor of primary care health services research2
  1. 1 Department of Social Medicine, University of Bristol, Bristol BS8 2PR,
  2. 2 Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol
  1. Correspondence to: J Sanders, Midwifery Led Unit, University Hospital of Wales, Cardiff CF14 4XN
  • Accepted 27 April 2006


Objectives To evaluate the effectiveness and acceptability of a lidocaine spray in reducing perineal pain during spontaneous vaginal delivery.

Design Randomised controlled trial.

Setting Consultant led obstetric unit.

Participants 185 women who had a spontaneous vaginal delivery without epidural analgesia.

Interventions Topically applied local anaesthetic spray (93 women) and placebo spray (92 women).

Main outcome measure Primary outcome measure was pain during delivery (0-100 scale). The 16 secondary outcome measures included second degree perineal trauma during delivery, trauma of the genital tract, and dyspareunia by two months.

Results Lidocaine spray did not reduce pain during spontaneous vaginal delivery: mean 77 and 72 on a scale of 0-100 in the lidocaine and placebo groups, respectively (difference between means 4.8, 95% confidence interval −1.7 to 11.2). Lidocaine spray may reduce genital tract trauma during delivery, in particular second degree perineal trauma. The intervention was highly acceptable to the women and midwives.

Conclusions Although lidocaine spray applied to the perineum during spontaneous vaginal delivery did not reduce perineal pain, it was acceptable to both the women and the midwives.

Trial registration Current controlled trials ISRCTN99732966 [].


  • Funding This research was carried out while JS was in receipt of Medical Research Council/Wales Office of Research and Development special training fellowship in health services research, with additional funding for the trial provided by Wellbeing for Women and the Obstetric Anaesthetists Association.

  • Competing interests None declared.

  • Ethical approval This trial was approved by the Medicines Control Agency, the local research ethics committee and the participating NHS trust research and development directorate.

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