Yonkeura 1987

Methods	Multi‐arm RCT – 4 group.
Participants	Women > 15 years with moderate to severe episiotomy pain after normal vaginal birth at Women’s Hospital, Los Angeles County. Women with a history of reaction or hypersensitivity to NSAID or salicylates, receiving perineal < 1 hour before entry to study, received analgesics, sedatives, psychotropic medications, or topical perineal anaesthetics within 4 hours of entering study or had an active disease that might interfere with the evaluation of study medications, were excluded.
Interventions	Intervention: meclofenamate 200 mg (N = 55); meclofenamate 100 mg (N = 55) and codeine 60 mg (N = 53). Comparison: placebo (N = 52).
Outcomes	Pain intensity (0 = none, 1 = slight, 2 = moderate, 3 = severe). Pain relief (0 = none, 1 = a little, 2 = some, 3 = a lot, 4 = complete). Additional medications (within 6 hours). Side effects = this outcome was not considered in the analysis as adverse reactions were reported at 24 hours following the treatment regime (i.e. after more than single dose was administered). Pain measures were assessed at baseline prior to treatment, at 30 minutes after and hourly thereafter to 6 hours.
Notes	Codeine 60 mg not considered for the review as not an NSAID.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No clear statement on method used.
Allocation concealment (selection bias)	Unclear risk	No clear statement.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Double‐blind.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No clear statement.
Incomplete outcome data (attrition bias) All outcomes	Low risk	The attrition rate was 0%, but 5 of 220 (2%) participants were excluded from efficacy analysis because of protocol violation.
Selective reporting (reporting bias)	Low risk	Pre‐specified outcomes were all reported.
Other bias	Low risk	No differences in baseline characteristics.