Efficacy of energy-based devices on episiotomy pain and healing: A systematic review and meta-analysis.

BACKGROUND

Episiotomy is a common obstetric procedure often associated with significant postpartum pain and delayed wound healing. Conventional treatments provide limited relief and might not be suitable for all women. Energy-based therapies, including infrared irradiation and low-level laser therapy (LLLT), a non-thermal photo biomodulation technique, have shown potential for enhancing pain relief and tissue recovery, but their effectiveness in post-episiotomy care remains unclear.

OBJECTIVE

This study evaluates the efficacy of energy-based treatments on pain reduction and wound healing following episiotomy in postpartum women.

METHOD: A database search was performed using MEDLINE with Ovid and PubMed interfaces, The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov and Web of Science up to December 2024. Prospective randomized and non-randomized controlled trials were considered for inclusion. No restriction was imposed regarding the year or language of publication. Included studies compared one method of energy-based treatment to placebo, standard of care, no treatment or another intervention. Data were synthesized using RevMan Web (Version 8.14.0) with a random-effects model to account for interstudy heterogeneity. Pooled results were expressed as standardized mean differences (SMDs) with 95% confidence intervals. Evidence certainty was assessed using the GRADE approach.

RESULTS

A total of 173 studies were identified through database searches, of which 13 studies were included in the final analysis, encompassing a total of 1377 patients. Analyses were stratified by intervention type: infrared irradiation versus standard care or no treatment (n = 1088), LLLT versus placebo (n = 209) and LLLT versus therapeutic ultrasound (n = 80). Infrared irradiation reduced postpartum pain compared to standard care or no treatment (SMD = -0.50, 95% confidence interval [CI]: -0.98 to -0.02, I2 = 88%, P < 0.01); however, it did not improve healing measures. LLLT showed no improvement in pain reduction (SMD: -0.31, 95% CI: -0.72 to 0.11, I2 = 53%, P = 0.1) or healing (SMD: 0.23, 95% CI: -0.18 to 0.63, I2 = 0%, P = 0.85) compared to placebo. LLLT compared to therapeutic ultrasound did not show advantage in pain or healing and was hindered by very high heterogeneity.

CONCLUSION

Infrared therapy might reduce pain after episiotomy, although its effect on wound healing remains inconclusive. LLLT did not demonstrate significant benefits for pain relief or healing.

PROSPERO REGISTRATION: CRD42024608543; registered December 2024.