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Comparative Efficacy of Anesthesia Versus Osteopathic Manipulative Treatment for Pain Outcomes in Postpartum Women: A Systematic Review and Meta-Analysis
Belli, J. [1]
Ramaraju, R. [1]
Myers, N. [7]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A622–623. doi: Subito , type of study: Meta analysis

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

anesthesia [8]
caesarean section [16]
childbirth [54]
female [629]
meta analysis [72]
OMT [3779]
osteopathic manipulative treatment [3799]
postpartum [18]
women [582]

Abstract:

Context: Pain following cesarean section (C-section) and vaginal delivery is a common complication due to surgical scars and the healing process. The current standard to manage pain following childbirth includes a multimodal analgesic approach which requires the use of long-acting neuraxial opioids and adjunct drugs [1]. While many women who give birth opt to receive epidural anesthesia, a significant number of women prefer a drug-free labor process that includes osteopathic manipulative treatment (OMT). Current literature focuses on the use of anesthetics and OMT as two separate entities to mitigate postpartum pain. However, existing literature lacks a comprehensive analysis of the role of anesthetics compared to the role of OMT in the effectiveness of reducing postpartum pain in C-section and vaginal delivery patients. Objective: To determine whether there is a significant difference in Visual Analogue Scale (VAS) scores of pain experienced in C-section patients who receive anesthesia compared to C-section and vaginal delivery patients who receive OMT. Methods: A systematic review and meta analysis of four databases (PubMed, JAOA, Google Scholar, and Cochrane Library) was completed following the PRISMA 2020 guidelines. Study types selected for analysis included randomized controlled trials (RCTs) and cohort studies. The inclusion criteria consisted of studies that utilized the Visual Analogue Scale for pregnant patients who received either local anesthesia or OMT as options for pain relief. Patients who received local anesthesia were further narrowed to C-section delivery, whereas OMT included both C-section and vaginal delivery. VAS scores were specifically analyzed at 24 hours postpartum. Of the 167 studies screened, 8 studies and 569 patients satisfied the criteria. Statistical analyses were conducted using R (version 4.3.0, 2023), and a random-effects meta regression model was conducted to compare mean VAS scores in order to account for between-study heterogeneity. Results: The pooled random-effects mean VAS scores among pregnant patients following administration of anesthesia (n = 334) and OMT techniques (n = 225) were 2.10 (95% CI 0.98, 3.22) and 2.84 (95% CI 2.23, 3.45), respectively. Using the random-effects meta regression model to account for heterogeneity (τ2 = 1.11), the predicted mean VAS scores was 2.10 (95% CI 1.18, 3.02) after administration of anesthesia and 2.88 (95% CI 1.96, 3.80) after implementation of OMT. VAS scores in the OMT group were 0.78 points higher than the anesthesia group (β coefficient = 0.78; 95% CI -0.62, 2.18; p = 0.23) which was not a statistically significant difference. Conclusion: Labor pain is among the most severe types of physical pain that women may experience in their lifetime [2]. While epidural anesthesia is considered the most effective method of pain relief during labor, the findings of our study indicate that there is no statistically significant difference in pain reduction between anesthesia and OMT techniques following childbirth, thus offering a possible alternative to efficiently manage postpartum pain. A limitation to this study included the lack of existing data on patients who received OMT after C-section (n = 22). Therefore, it was necessary to analyze both C-section and vaginal deliveries for OMT patients. More studies on OMT patients who had C-sections are necessary to further support the findings in this study.

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