The Use of Rectal Diclofenac Sodium Versus Intravenous Paracetamol for Post Cesarean Section Analgesia

Abstract

Background 
 Pain management is one of the most important aspects of postoperative care. Pain causes unpleasant experiences such as prolongation of postoperative recovery and development of stress reactions. Pain relief is of great importance in patients with Cesarean section by relaxing the mother, enhancing the ability of self-care, resulting into early discharge and subsequently reduces nosocomial infections and hospitalization costs.
 Objectives
 To compare the analgesic efficacy of Diclofenac sodium suppository (100 mg) versus intravenous paracetamol (1000 mg) in postoperative pain management for women undergoing Caesarean section.
 Patients and Methods
 This study is a single blinded randomized clinical trial conducted in Sulaimani Maternity Teaching Hospital from 1st of June 2018 to 1st of February 2019 on 124 pregnant women who underwent 1st or 2nd Caesarean section under spinal anesthesia without any medical disease or drug allergy. After obtaining informed consent from the participants, patients were randomly divided into two groups. Group A (62 patients) received 100 mg rectal Diclofenac sodium, Group B (62 patients) received 1000 mg intravenous Acetaminophen immediately after cesarean section. The patients were observed for 12 hours after the end of surgery. The pain intensity was judged using McGill pain scale at time periods 1, 6 and 12 hours after the ending of surgery.
 Results
 Mean pain score was significantly lower at 1, 6 and 12 hours of Diclofenac sodium group comparing to that of paracetamol group p<0.001. After 1 hour, 60 patients (96.8%) in Diclofenac group had no pain, while 26 of paracetamol group (41.9%) had no pain The paracetamol group significantly needed more additional analgesia than Diclofenac group P<0.001. No side effects were recorded in any of the two groups.
 Conclusion
 For post Cesarean pain relief, rectal Diclofenac sodium was found to be safe and effective and has much better analgesic effect than intravenous paracetamol infusion.