To systematically and meta-analytically examine the efficacy of ropivacaine versus lidocaine infiltration for controlling postpartum perineal pain secondary to spontaneous tear or selective episiotomy.

We searched four databases from inception to 20-September-2020. We included all relevant randomized and nonrandomized studies and assessed their risk of bias. We pooled data as standardized mean difference (SMD), weighted mean difference (WMD), or odds ratio (OR) with 95% confidence intervals (95% CIs).

Four studies met the inclusion criteria (one and three studies were nonrandomized and randomized, respectively). There were 405 patients; 205 and 200 patients received lidocaine and ropivacaine, respectively. There was no significant difference between ropivacaine and lidocaine groups with regard to visual analogue scale (VAS) pain scores at suturing (WMD= -0.04, 95% CI [-0.41, 0.32], P = 0.82), 2 hours (SMD= -1.50, 95% CI [-3.50, 0.50], P = 0.14), and 24 hours (SMD= -0.40, 95% CI [-1.15, 0.34], P = 0.29) post repair of perineal trauma. Proportion of patients with mild VAS pain score ≤3 at 24 hours was significantly higher in the ropivacaine group (OR = 4.34, 95% CI [2.03, 9.29], P < 0.001). Proportion of patients who did not require additional analgesia during the first 24 hours post perineal repair did not significantly differ between both groups (OR = 2.44, 95% CI [0.09, 68.21], P = 0.60). Ropivacaine group achieved higher maternal satisfaction (OR = 7.13, 95% CI [3.63, 13.99], P < 0.001).

During repair of postpartum perineal trauma, pain efficacy is relatively longer with ropivacaine but safety is not well investigated. High-quality and large-sized studies are needed to consolidate these findings.