[[alternative]]The effects of cold packing on relieving episiotomy wound pain

[[abstract]]本研究旨在探討產後婦女局部冷敷緩解會陰傷口疼痛之成效。採類實驗法前、後測對照組進行研究，採立意取樣，收案場所為北部某區域教學醫院之產後病房，實驗組及控制組共70人，每組各35人。控制組產婦維持常規口服止痛藥使用，實驗組產婦除常規口服止痛藥外並介入會陰傷口局部冷敷，每天至少3次，每次時間15分，於產後4小時執行前測，產後12、24及48小時執行後測，以評估會陰疼痛緩解程度、會陰疼痛干擾日常活動程度、會陰疼痛干擾母乳哺餵程度、會陰疼痛干擾親子活動程度、疼痛控制滿意度、會陰傷口癒合之成效及產後第一次自解尿之影響。研究工具包括：產婦基本資料表、疼痛視覺類比量表（Visual Analogue Scales，VAS）、簡易疼痛量表（Brief Pain Inventory Short From, BPI-S）、疼痛控制滿意度量表及REEDA（Redness、Edema、Ecchymosis、Discharge、Approximation）會陰傷口評分量表；資料收集後使用SPSS 18.0統計軟體，以獨立樣本t檢定、卡方檢定、共變數分析（analysis of covariance, ANCOVA）、概似化函數估計式（Generalized Estimating Equation model, GEE）進行資料的處理與分析。 研究結果顯示兩組於基本人口學及產科學並無顯著差異；兩組前測（產後4小時）評估指標之比較，發現疼痛干擾日常活動總分（p=.02）、疼痛干擾親子同室程度（p=.03）及疼痛干擾母乳哺餵程度（p=.04）具顯著差異；將年齡及第二產程時間等干擾因子列入共變異後，以ANCOVA 分析兩組產後第一次自解尿時間達到顯著差異（p<.05）；在排除干擾變項：年齡、胎次、第二產程時間及會陰創傷程度後，以GEE分析兩組時間與組別交叉作用顯示，除會陰傷口癒合未達顯著成效外，其餘結果變項皆達到顯著差異。實驗組之疼痛分數除了產後12小時外，其餘皆低於控制組，且隨著產後時間越長疼痛減輕越明顯，於產後48小時達到統計上的顯著差異（p<.05）；實驗組之會陰疼痛干擾日常活動分數皆低於控制組，且隨著產後時間越長會陰疼痛干擾日常活動程度降低的越明顯，於產後12、24及48小時達到統計上的顯著差異（p<.05）；實驗組之疼痛干擾母乳哺餵分數皆低於控制組，且隨著產後時間越長疼痛干擾母乳哺餵分數降低的越明顯，於產後12、24及48小時達到統計上的顯著差異（p<.05）；實驗組之疼痛干擾親子同室分數皆低於控制組，且隨著產後時間越長親子同室分數降低的越明顯，於產後12、24及48小時達到統計上的顯著差異（p<.05）；實驗組之疼痛控制滿意度分數皆低於控制組，且隨著產後時間越長疼痛控制滿意度分數降低的越明顯，於產後12、24及48小時達到統計上的顯著差異（p<.05）。 本研究結果，顯示會陰冷敷能有效緩解會陰疼痛、降低疼痛對日常活動干擾、母乳哺餵及親子同室之干擾程度、提升疼痛控制滿意度及提早產後第一次解尿時間，值得於臨床推廣。[[abstract]]The purpose of this study was to examine the effects of application of cold packs on reliving episiotomy wound pain. The study used a quasi-experimental design with nonprobability sampling. Data of the study were collected at a maternal ward in a regional teaching hospital in Northern Taiwan. Seventy postpartum women participated in the study and were assigned to interventional and comparison group (35 mothers in each group). Participants in the comparison group took pain medicine as routine. Participants in the interventional group applied cold packs on episiotomy wound for 15 minutes at a time, 3 times a day and took pain medicine as well. Measured variables included level of episiotomy wound pain; influence of episiotomy wound pain on daily activities, breastfeeding, and mother-baby interactions; satisfaction with pain management; healing of episiotomy wound, and time of first-time urination after childbirth. These variables were measured at 4 hours after childbirth but before application of cold packs (pretest) and at 12, 24, and 48 hours postpartum (posttests). Instruments used in the study included maternal demographic information sheet, Visual Analogue Scales for pain, Brief Pain Inventory Short From, and REEDA for episiotomy wound assessment. Data were analyzed using SPSS (version 18.0). Independent t test, Chi square, ANCOVA, and generalized estimating equation model were used. Results showed that there were no differences on the participants’ demographic and obstetrical characteristics between two groups. The participants in two groups significantly differed in their perception of influences of pain on daily activities (p=.02), mother-baby interactions (p=.03), and breastfeeding (p=.04) at pretest. After controlling for age and duration of the second stage of labor, ANCOVA analysis found a difference between two groups in time of the first-time urination after childbirth (p<.05). After controlling for covariates (age, parity, duration of the second stage of labor, and level of episiotomy wound laceration), GEE revealed significant differences on all measured variables between two groups except for episiotomy wound healing. Mothers in the interventional group experienced a lower level of pain than mothers in the comparison group at all data collection times except for at 12 hours postpartum. In addition, level of pain decreased over time and reached a statistical significance at 48 hours postpartum (p<.05). Regarding influence of pain on daily activities, participants in the interventional group had lower scores than scores of participants in the comparison group and the influence decreases at 12, 24, and 48 hours postpartum (p<.05). Pain influenced breastfeeding. Participants in the interventional group scored lower on the influences of pain on breastfeeding than participants in the comparison group at 12, 24, and 48 hours postpartum (p<.05). Pain influenced mother-baby interactions. Mothers in the interventional group scored lower on the influences of pain on mother-baby interactions than mothers in the comparison group at 12, 24, and 48 hours postpartum and the scores decreased more significantly as time passed by. Scores on the satisfaction with pain management were lower for mothers in the interventional group than mothers in control group at 12, 24, and 48 hours postpartum (p<.05) and the scores decreased more significantly as time passed by. Results of the study showed that application of cold packs on perineum was more effective in relieving episiotomy wound pain; decreasing influences of pain on daily activities, breastfeeding, and mother-baby interactions; increasing participants’ satisfaction with pain management; and resulting in earlier first-time urination after childbirth than did taking oral pain medicines along. The ice pack is convenient to use and therefore can be widely used in clinical