RECTAL VERSUS ORAL DICLOFENAC FOR RELIEF OF PERINEAL PAIN AFTER EPISIOTOMY REPAIR: A RANDOMIZED STUDY

Abstract

BACKGROUND: Episiotomy is the commonest obstetric surgical operation performed worldwide to increase the introitus to enhance vaginal delivery. Management of postoperative pain after perineal repair requires a balance between pain relief and undesirable side effects of drugs and route of administration. OBJECTIVES: The study was performed to compare the efficacy of rectal and oral diclofenac following the repair of episiotomy. METHOD: This prospective randomised study was carried out among the healthy parturient that had spontaneous vaginal delivery and had an episiorrhaphy at the Federal Medical Centre, Ido Ekiti, between December 2014 and May 2015. A total number of one hundred consecutive parturient (fifty in each arm) were randomised to either 100mg oral or 100mg rectal diclofenac 12hourly for 24 hours after perineal repair. A ten-point visual analogue scale (VAS) for pain recorded at one, four, eight sixteen and twenty-four hours was the primary outcome. The data generated was analyzed using the Statistical Package for Social Science (SPSS) software version 17. Statistical analyses were performed using Student’s t-test for parametric data and Mann-Whitney U-test for nonparametric data. Fisher’s exact test with Yates correlation was performed where appropriate. Results were expressed in simple percentages, means and standard deviations. Frequency tables were made and results tested for significance using the chi-square test with the level of significance set at p≤ 0.05. RESULTS: There was no significant difference between the randomised groups in any socio-demographic characteristics. The mean age of oral diclofenac group was 29.9 ± 5.4, while that of rectal diclofenac group was 30.8 ± 4.6 years (χ2-0.880, p=0.81). There was no statistically significant difference in maternal weights between the two groups (71.6±9.6 versus 70.2± 6.9, p=0.387) in the oral and rectal diclofenac groups respectively. The mean gestational age at delivery between the oral and rectal groups (39.0 ± 2.0 vs. 39.2 ± 1.3, p=0.555) was not statistically significant. There is no statistically significant difference in the requirement for rescue analgesia between the oral and rectal diclofenac groups. The mean VAS pain score was 1.7 ± 1.7 vs. 0.8 ± 0.7, (p=0.011) and 0.2 ± 0.5 vs. 0.0 ± 0.0, (p= 0.012) in the oral and rectal diclofenac groups respectively at 4 and 24hours post-repair on a ten-point VAS. This difference is statistically significant. Randomisation to rectal diclofenac was associated with no upper gastro-intestinal symptom (0 vs. 18%, p=0.003). However the need for additional analgesia for breakthrough perineal pain was not significantly different (mean-SD 0.0±0.2 versus 0.0±0.1, p=0.560). CONCLUSION: Based on the results of this study, rectal diclofenac had better analgesic effects and lesser upper gastro-intestinal adverse effects than oral diclofenac for post-perineal repair pain after episiotomy.

RECTAL VERSUS ORAL DICLOFENAC FOR RELIEF OF PERINEAL PAIN AFTER EPISIOTOMY REPAIR: A RANDOMIZED STUDY