Comparison of Postoperative Pain Control with Combined Rectal Diclofenac and Oral Paracetamol Versus Rectal Diclofenac in Cesarean Delivery under Spinal Anesthesia

Abstract

Background and Objectives: It is necessary to use an appropriate analgesic protocol for alleviating post cesarean section pain. It creates a better environment for mother for early communication with her baby. Opioid have several side effects. Considering recently attention for multi-drug methods and different analgesic mechanism of Diclofenac and Paracetamol, we studied wether combination use of Diclofenac and Paracetamol could be more effective than using each one alone or not. Materials and Methods: In this study 95 candidates of C/S with spinal anesthesia randomly assigned in two groups. In their postoperative period, analgesic protocol for the control group was Diclofenac suppositories 100mg every 8 hours. Case group received acetaminophen tablets (500mg) every 6 hours, combined with Diclofenac suppositories (75mg) every 12 hours. Pain intensity was assessed at 2, 4, 6, 8, 12 and 24 hours after surgery using visual analogue scale (VAS). Results: 51 women (age 30.39±5.02 years) were our cases and 44 women (age 28.55±4.78) were our controls. Visual analogue scales at 2, 4, 6, 8, 12 and 24 hours after surgery in case group was significantly lower than controls. (P<0.05). 21 persons in case group and 27 persons in control group received additional analgesia (P=0.039, Fisher`s Exact Test). There was not a significant increase in side effects in combination theory group. Conclusion: Concomitant use of oral paracetamol and rectal Diclofenac suppositories is more effective than Diclofenac suppository alone for decreasing postoperative pain after cesarean section.

Keywords: Cesarean section, Diclofenac, Paracetamol, Visual Analogue Scale