ADJUVANT RECTAL DICLOFENAC FOR POST OPERATIVE PAIN CONTROL AFTER CAESAREAN SECTION: A RANDOMIZED CONTROLLED TRIAL

ADJUVANT RECTAL DICLOFENAC FOR POST OPERATIVE PAIN CONTROL AFTER CAESAREAN SECTION: A RANDOMIZED CONTROLLED TRIAL

Abstract

BACKGROUND: Pain management following caesarean section still remains a
challenge in our environment. Diclofenac suppository is an effective adjunct
analgesic for post operative pain control.
OBJECTIVE: To compare the efficacy and safety of combined rectal Diclofenac and
intramuscular pentazocine with intramuscular pentazocine alone for post operative
pain control following transverse lower segment caesarean section.
DESIGN: A prospective randomized, placebo controlled trial.
METHODOLOGY: A total of 120 low risk women scheduled for elective or
emergency transverse lower segment caesarean section under spinal anaethesia
with Bupivacaine, were randomized into two equal groups to receive either 50mg
Diclofenac suppository 8 hourly for 24 hours or one Anusol suppository( the placebo)
8 hourly for 24 hours. Both groups received IM pentazocine 30mg 6hourly for 24
hours as the primary analgesic. The primary outcome measure was the proportion
of patients with severe pains at 24 hours post operatively using the visual analogue
rating scale. Secondary outcome measures were the time from surgery to
ambulation, time from surgery to first passage of flatus, maternal satisfaction with
analgesia, and presence of complications. Statistical analysis was performed using
Student’s t-test for continuous variables and chi-square test or Fisher exact test
(where appropriate) was used for categorical variables. P-value < 0.05 was
considered significant.
RESULT: Both groups were comparable with respect to mean age and mean body
mass index. There was no patient with severe pains at 24 hours post operatively in
the patients who had combined Diclofenac suppository and IM pentazocine
compared to 10% (6/60) of those who had IM Pentazocine and placebo suppository [
P= 0.027]. The time from surgery to ambulation was significantly shorter in the
Diclofenac group compared to the placebo group; 18.08 ± 5.36 hours versus 23.23 ±
6.85 hours [P < 0.0001] . Also, the mean time from surgery to first passage of flatus
was significantly shorter among patients in the Diclofenac group compared to those
in the placebo group; 20.58 ± 6.09 hours versus 23.22 ± 5.29 hours respectively [P=
0.013]. A significantly greater proportion of patients in the Diclofenac group were
satisfied with the method of analgesia compared to those in the placebo group;
93.3% (56/60) versus 78.3% (47/60) respectively [P= 0.017] . Post operative pyrexia
occurred in 3.3% (2/60) of patients in the Diclofenac group compared with 8.3%
(5/60) in the placebo group. This difference was however not statistically significant
[P= 0.439] . There was no case of secondary post partum haemorrhage or wound
haematoma among patients in both groups.
CONCLUSION: The use of 50mg of rectal Diclofenac administered 8 hourly for the
first 24 hours following transverse lower segment caesarean section is effective and
safe as an ‘adjunct analgesic’ to intermittently administered intramuscular
Pentazocine used as the primary analgesic agent. It is associated with a significant
reduction in the proportion of patients with severe pains assessed 24 hours post
operatively, and is associated with a better overall patient satisfaction compared to
intermittently administered intramuscular pentazocine alone.

ADJUVANT RECTAL DICLOFENAC FOR POST OPERATIVE PAIN CONTROL AFTER CAESAREAN SECTION: A RANDOMIZED CONTROLLED TRIAL

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