The efficacy of Diclofenac for post caesarean section analgesia: comparison of rectal and intramuscular routes
Background: Despite advances in postoperative pain therapy, pain relief may still be inadequate for a substantial number of women.
Aim: The aim was to compare the analgesic efficacy of rectal and intramuscular diclofenac for post Caesarean section analgesia.
Materials and Methods: Following approval from the Hospital Ethics Committee 94 ASA I and II parturients aged 18 years and above scheduled for elective Caesarean section under spinal anaesthesia were recruited into the study. While one group of parturients received 100 mg Diclofenac suppository rectally (group R) those in the other group received 75 mg Diclofenac intramuscularly (group IM) immediately after surgery. The patients were instructed to request analgesic when they felt pain post-operatively. Pain scores were recorded using the VAS (0 to 10), (0 = no pain, 10 = the most severe pain), initially every 30 minutes for the first 2 hours, then every 2 hours from the 2nd hour to the 8th hour and every 4 hours after the 8th hour till the 24th hour.
Results: The demographic data, BMI, PCV and ASA classification between the two groups of patients were comparable; the two groups were also comparable in the haemodynamic variables (mean systolic BP, mean diastolic BP, mean MAP and mean heart rate) and in the mean SpO2 recorded in the recovery room, p > 0.05 for all the variables. The time to first analgesic request in group IM was 313.2 ± 218.8 mins and in group R 314.1 ± 121.6 mins, p=0.98. There was no significant difference between the IM/R groups in the mean VAS scores of patients, the number of patients who received pentazocine at each time interval in the two groups, and the total pentazocine consumption in the two groups in 24 hours, p>0.05 in all the variables. There was no significant difference between the two groups in the mean satisfaction score in pain relief, p = 0.73, the mean satisfaction score with staff's response to patient's pain management needs, p = 0.85, and the mean acceptability score, p = 0.62.
Conclusion: Suppository diclofenac administered through the rectal route is as efficacious as intramuscular diclofenac injection for post Caesarean section analgesia with equal levels of patient satisfaction and acceptability.
Keywords: Post Caesarean section analgesia, diclofenac, rectal, intramuscular, spinal anaesthesia,