Repeated Pudendal Nerve Block and Physiotherapy for Prevention of Chronic Post-Episiotomy Pain

This prospective, single-center, open-label, randomized controlled trial will evaluate whether repeated ultrasound-guided pudendal nerve block combined with standardized physiotherapy and standard postpartum analgesic management reduces persistent post-episiotomy pain and postpartum dyspareunia compared with standard management alone. Women aged 18-40 years who have undergone vaginal delivery with episiotomy or a first-time perineal tear and who report postpartum pain greater than 3/10 within 24 hours after delivery will be randomized in a 1:1 ratio. The intervention group will receive standard management plus a repeated pudendal nerve block before hospital discharge and a second block on postpartum Day 10 if pain remains greater than 3/10. Pain and sexual function will be assessed through 3 months postpartum.

Inclusion Criteria: Participants must meet all of the following: * Women aged 18-40 years. * Term pregnancy. * Vaginal delivery with episiotomy or first-time perineal tear. * Postpartum pain score \>3/10 within 24 hours after delivery. * Willingness to participate and provide informed consent. - Exclusion Criteria: * Refusal to participate. * Previous episiotomy or perineal tear. * Pain score ≤3/10. * Known allergy to study medications. * Pre-existing pudendal neuralgia. * Pre-existing dyspareunia.