Summary of findings 6. NSAID compared to herbal analgesia for relief of pain due to uterine cramping/involution after birth.
| NSAID compared to herbal analgesia for relief of pain due to uterine cramping/involution after birth | |||||
| Patient or population: women who have given birth vaginally, requiring analgesia for after‐birth pains. Setting: hospital obstetric inpatients (Iran) Intervention: NSAID Comparison: herbal analgesia | |||||
| Outcomes | № of participants (studies) | Certainty of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | |
| Risk with placebo | Risk difference with NSAID versus herbal analgesia | ||||
| Adequate pain relief as reported by the woman (1 to 4 hours) |
394 (4 RCTs) | ⊕⊝⊝⊝ VERY LOW a,b | RR 0.96 (0.78 to 1.18) | Study population | |
| 462 per 1000 | 18 fewer per 1000 (102 fewer to 83 more) | ||||
| Need for additional pain relief (4 hours) |
90 (1 RCT) | ⊕⊝⊝⊝ VERY LOWa,b,c | RR 1.00 (0.44 to 2.29) | Study population | |
| 200 per 1000 | 0 fewer per 1000 (112 fewer to 258 more) | ||||
| Maternal adverse events (1 hour) |
108 (1 RCTs) | ⊕⊝⊝⊝ VERY LOWb,c,d | RR 5.00 (0.60 to 41.39) | Study population | |
| 19 per 1000 | 74 more per 1000 (7 fewer to 748 more) | ||||
| Neonatal adverse events | Not reported | ||||
| Duration of hospital stay | Not reported | ||||
| Any breastfeeding at hospital discharge | Not reported | ||||
| Any breastfeeding at 6 weeks postpartum | Not reported | ||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
aDowngraded two levels for very serious concerns about limitations in study design: risk of bias ‐ some of the studies included have some domains of risk of bias assessed as unclear (selective outcome reporting) or high risk (allocation concealment, blinding, selective outcome reporting). bDowngraded one level due to serious concerns about indirectness: some study interventions were not therapeutic doses. cDowngraded two levels due to very serious concerns about imprecision: few participants, few events and wide confidence intervals. dDowngraded one level due to serious concerns about limitations in study design: risk of bias ‐ unclear risk of selective outcome reporting.