Effective analgesia following perineal injury during childbirth: a placebo controlled trial of prophylactic rectal diclofenac

Abstract

Objective To determine if diclofenac suppositories administered prophylactically produce effective Design A randomised double blind placebo controlled trial. Setting York District Hospital.Population One hundred women sustaining objective perineal injury (second degree tear or episiotomy) during spontaneous vaginal delivery at term.Methods Suppositories were administered at the time of repair and approximately 12 hours later. The suppositories were randomised prior to issue by the pharmacy department and contained either 100 mg diclofenac or placebo.Main outcome measures Pain scores assessed at 12, 24, 48 and 72 hours after delivery using a six point numerical scoring system and the use of additional analgesia and local treatments to the perineum. ResultsThe mean pain score was significantly reduced in the diclofenac group at 24, 48 and 72 hours after delivery (0.86, 0.7 and 0-59, respectively) compared with the control group (1.64, 1.31 and 1.5; P < 0.005). In addition there was less supplementary analgesia required (eight women only at 72 hours compared with 15 in the control group) and this was limited to paracetamol or topical treatments to the perineum. ConclusionProphylactic rectal diclofenac provides effective analgesia after perineal repair and its effect appears to be maintained into the second and third postpartum days.and lasting analgesia following perineal injury.

Decreased postpartum use of oral pain medication after a single dose of epidural morphine

“…Although this might indicate that the problem of pain postpartum is less significant than we believed at the outset of our study, most literature does indicate that many women suffer significant pain after normal vaginal deliveries. 10,12,13 Our choice to allow 1 of 2 opioidcontaining medications to be administered could be questioned, although it probably did not affect our results. We chose to study nulliparous women hav- ing relatively uncomplicated deliveries to have as homogeneous a sample population as possible, but epidural opioid administration may be more effective in multiparous women, those undergoing instrumental delivery, or those with significant perineal injuries.…”

“…The treatment of postpartum pain has not been extensively studied, but the use of topical lidocaine ointment, different methods of suturing, and both oral and rectal nonsteroidal antiinflammatory drugs have been assessed and have not been shown to be particularly effective. [10][11][12][13] There have been only 2 studies of a 2-mg dose of epidural morphine for treatment of postpartum perineal pain. 5,6 We found that epidural morphine given immedi-ately after vaginal delivery decreased the amount of oral pain medication used in the first 24 hours postpartum.…”

Puerperal complications of episiotomies at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

“…In this study, the mean duration of analgesic therapy for perineal pain was 4.8 days in women who had episiotomies, and only one patient (1.32%), required analgesia for perineal pain for eight days. It has been reported that diclofenac rectal suppositories administered at the time of repair of perineal injury including episiotomies, provides effective analgesia that may continue for up to three days postpartum (17). Assessment of the role of diclofenac in minimising post-episiotomy pain is required in this environment.…”

Comparison of intramuscular diclofenac sodium, diclofenac sodium suppository and intravenous tramadol for postoperative analgesia in gynaecological surgeries done under spinal anaesthesia

“…13 Searles JA et al, observed that no patient had nausea and vomiting in diclofenac suppository group. 22 In our study, 6 patients (20%) in Inj. diclofenac group complaint of pain at the injection site.…”