The Analgesic and Hemostatic Effects of Diclofenac as Adjuvant of Intravenous Opioid Using PCA after Cesarean Section

Comparison of different nonsteroidal anti-inflammatory drugs for cesarean section: a systematic review and network meta-analysis

“…In all, we included 47 trials in this review [10,11, and details of the screening process are illustrated in Figure 1. The following interventions were compared: control vs celecoxib in two trials [35,46]; control vs celecoxib + parecoxib in one trial [57]; control vs diclofenac in 24 trials [11, [25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][65][66][67][68][69]; control vs diclofenac vs indomethacin in one trial [44]; control vs diclofenac vs ketoprofen in one trial [45]; control vs ibuprofen vs ketorolac in one trial [47]; control vs indomethacin in one trial [48]; control vs ketorolac in six trials [10,[49][50][51][52][53]; control vs naproxen in one trial [54]; control vs parecoxib in one trial [55]; control vs tenoxicam in six trials [56,[58][59][60][61][62]; diclofenac vs ketoprofen in one trial…”

“…The findings of the risk of bias assessment are presented in Figure 2. Overall, only four trials were deemed to be at low risk of bias [10, 54,55,68], and 30 and 13 of the remaining trials were evaluated to have some concerns [25,[27][28][29][30][31][32][33][34][35]37,38,[43][44][45]47,49,52,53,[57][58][59][60][61][62][63][64][65][66][67]] or be at high risk of bias [11,26,36,[39][40][41][42]46,48,50,51,56,69], respectively. Many of the concerns were related to the randomization process, measurement of the outcome and the selection of the reported result.…”

“…In regard to the nature of the cesarean section, it was elective, elective or emergent and not specified in 30 [10,26,29,31-35,37,38,45,48-51,53-58,60-62,64-69], six [11,30,[40][41][42][43] and 11 [25,27,28,36,39,44,46,47,52,59,63] trials, respectively. The mode of anesthesia was spinal, combined spinal-epidural, epidural or general anesthesia in 27 [10,11,29,32-35,37-39,41-44,46,48,50,54-56,60-64,68,69], two [51,57], three [49,66,67] and 11 [25][26][27][28]30,31,47,53,58,59,65] trials, respectively. Of the remaining trials, one performed spinal or epidural anesthesia [45], two used neuraxial or general anesthesia [40,52] and one did not specify the type of anesthesia [36].…”

“…In addition to NSAIDs, women received propacetamol or paracetamol in four trials [32,33,37,57]. The route of administration of NSAIDs was as follows: oral in two trials [35,46]; intramuscular in 13 trials [25,27,28,31,34,36,38,40,43,49,[65][66][67]; intravenous in 16 trials [10,11,39,45,[50][51][52][53]55,56,[58][59][60][61][62]64]; rectal in 11 trials [26,29,30,32,33,41,42,44,48,68,69]; oral or intramuscular in one trial [47]; intravenous and oral in one trial [57]; intramuscular or intravenous in one trial [63]; and rectal and oral in two trials [37,…”

“…In contrast to diclofenac, indomethacin, ketorolac and tenoxicam, control was not inferior to other NSAIDs such as celecoxib and parecoxib for the cumulative morphine consumption at 24 h. It is likely that this could be a reflection of the limited evidence base for these NSAIDs, resulting in imprecision and wide confidence intervals, and the different dosing regimens employed in the included trials. In many trials which investigated diclofenac, indomethacin and ketorolac, more than one dose of the NSAID was administered in 24 h [25,[27][28][29][30][31][32][33]37,38,40,[42][43][44][45]48,[50][51][52][53]. Further, tenoxicam has a long mean elimination half life of 67 h [70], explaining its beneficial effects on morphine consumption despite only being given once in relevant trials [56,[58][59][60][61][62].…”