Effectiveness of rectal versus oral diclofenac for perineal pain relief following episiotomy repair at a tertiary hospital in port harcourt, Nigeria: A randomized controlled study.

Abstract

Background: Perineal pain following episiotomy repair is a common complaint after vaginal delivery and may be severe,
requiring the use of strong analgesics. Diclofenac is a non-steroidal anti-inflammatory drug commonly used for pain relief.
This study aimed to compare the effectiveness of rectal versus oral Diclofenac in the management of pain post-episiotomy
repair.
Methodology: A prospective double-blind randomized controlled study was carried out involving 132 booked mothers who
had episiotomy repair after vaginal delivery at a tertiary hospital in Port Harcourt, Nigeria. They were randomized into two
groups and received either rectal diclofenac 100mg and oral placebo 12 hourly (Group A), or oral diclofenac 100mg and rectal
placebo 12 hourly (Group B), for 48 hours following the repair. Perineal pain was measured using Visual Analogue Scale
(VAS). Both groups were monitored for 48 hours (pain relief assessed at 6, 12, 18, 24, 36 and 48) and the analgesic
effectiveness compared. The data obtained was analysed using IBM SPSS version 24. The recruitment spanned from 1st
September 2023 to 30th January 2024.
Results: Both groups were similar in their baseline socio-demographic characteristics. The overall mean pain score was
significantly lower in the rectal diclofenac group than the oral diclofenac group (4.14±0.42 vs. 4.30±0.44, t=2.01, p=0.048).
Majority of the participants in the rectal route expressed more satisfaction (66.7% vs. 37.1%, χ2=23.08, p<0.01). The mean
time interval (hours) between drug administration and the first urine void was similar in both groups (3.19±3.13 vs. 3.29±3.11,
t=0.29, p=0.74), and there was no difference in the requirement for additional analgesia (12.1% vs. 9.1%, χ2=0.32, p=0.57).
Conclusion: Diclofenac suppository was more effective in the management of perineal pain following episiotomy repair, and the
participants in the rectal route group expressed more satisfaction than their counterparts who received the oral drug.