title: A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: a pilot study.
abstract: OBJECTIVE
  to evaluate the effects of low-level laser therapy for perineal pain and healing after episiotomy.
  
  
  METHODS
  a double-blind, randomised, controlled clinical trial comparing perineal pain scores and episiotomy healing in women treated with low-level laser therapy (LLLT) and with the simulation of the treatment.
  
  
  METHODS
  the study was conducted in the Birth Centre and rooming-in units of Amparo Maternal, a maternity service located in the city of São Paulo, Brazil.
  
  
  METHODS
  fifty-two postpartum women who had had mediolateral episiotomies during their first normal delivery were randomly divided into two groups of 26: an experimental group and a control group.
  
  
  METHODS
  in the experimental group, the women were treated with LLLT. Irradiation was applied at three points directly on the episiotomy after the suture and in three postpartum sessions: up to 2 hrs postpartum, between 20 and 24 hrs postpartum and between 40 and 48 hrs postpartum. The LLLT was performed with diode laser, with a wavelength of 660 nm (red light), spot size of 0.04 cm(2), energy density of 3.8 J/cm(2), radiant power of 15 mW and 10s per point, which resulted in an energy of 0.15 J per point and a total energy of 0.45 J per session. The control group participants also underwent three treatment sessions, but without the emission of radiation (simulation group), to assess the possible effects of placebo treatment.
  
  
  RESULTS
  perineal pain scores, rated on a scale from 0 to 10, were evaluated before and immediately after the irradiation in the three sessions. The healing process was assessed using the REEDA scale (Redness, Edema, Echymosis, Discharge Aproximation) before each laser therapy session and 15 and 20 days after the women's discharge.
  
  
  RESULTS
  comparing the pain scores before and after the LLLT sessions, the experimental group presented a significant within-group reduction in mean pain scores after the second and third sessions (p=0.003 and p<0.001, respectively), and the control group showed a significant reduction after the first treatment simulation (p=0.043). However, the comparison of the perineal pain scores between the experimental and control groups indicated no statistical difference at any of the evaluated time points. There was no significant difference in perineal healing scores between the groups. All postpartum women approved of the low-level laser therapy.
  
  
  CONCLUSIONS
  this pilot study showed that LLLT did not accelerate episiotomy healing. Although there was a reduction in perineal pain mean scores in the experimental group, we cannot conclude that the laser relieved perineal pain. This study led to the suggestion of a new research proposal involving another irradiation protocol to evaluate LLLT's effect on perineal pain relief.
authors: Health Sciences Institute, University Paulista, Rua Apeninos, 267, CEP 01533-000, São Paulo, Brazil. jaqueoliveira1@hotmail.com
authors: Jaqueline de Oliveira
authors: Jde O
authors: Santos
authors: Sonia Maria Junqueira Vasconcellos de
authors: SM
authors: Oliveira
authors: Moacyr Roberto Cuce
authors: MR
authors: Nobre
authors: Ana Cecília Correa
authors: AC
authors: Aranha
authors: Marina Barreto
authors: MB
authors: Alvarenga
mesh_terms: D000328:Adult; D001938:Brazil; D004841:Episiotomy / Q000009:adverse effects / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D010147:Pain Measurement / Q000451:nursing; D010149:Postoperative Pain / Q000451:nursing / Q000532:radiotherapy*; D010502:Perineum / Q000601:surgery; D010865:Pilot Projects; D011644:Puerperal Disorders / Q000451:nursing / Q000532:radiotherapy*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult