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THE USE OF RECTAL DICLOFENAC SODIUM VERSUS INTRAVENOUS PARACETAMOL FOR POST CESAREAN SECTION ANALGESIA
THE USE OF RECTAL DICLOFENAC SODIUM VERSUS INTRAVENOUS PARACETAMOL FOR POST CESAREAN SECTION ANALGESIA
Avan Khaleel Ismael a and Sallama Kamel Nasir b
Avan Khaleel Ismael a and Sallama Kamel Nasir b
a Sulaimani Maternity Teaching Hospital, Kurdistan Region, Iraq.
b Department of Gynecology and Obstetrics, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 23/5/2019; Accepted: 29/10/2019; Published: 21/12/2019
DOI Link: https://doi.org/10.17656/jsmc.10226
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.
KEYWORDS
Cesarean section, Analgesia, Diclofenac sodium suppository, Paracetamol infusion.
References
1. Olofsson CI, Legeby MH, Nygårds EB, Östman KM. Diclofenac in the treatment of pain after caesarean delivery: An opioid-saving strategy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2000 Feb 1;88(2):143-6.
2. Lee SY, Lee WH, Lee EH, Han KC, Ko YK. The effects of paracetamol, ketorolac, and paracetamol plus morphine on pain control after thyroidectomy. The Korean journal of pain. 2010 Jun 1;23(2):124-30.
3. Bakhsha F, Niaki AS, Jafari SY, Yousefi Z, Aryaie M. The effects of diclofenac suppository and intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia during cesarean section. Journal of clinical and diagnostic research: JCDR. 2016 Jul;10(7):UC09.
4. Akhavanakbari G, Entezariasl M, Isazadehfar K, Kahnamoyiagdam F. The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioids consumption after cesarean section. Perspectives in clinical research. 2013 Apr;4(2):136.
5. Pakartadbiri S, Rahimi EA. Comparison of morphine and piroxicam in decreasing post cesarean pain. Scientific Journal of Kurdistan University of Medical Sciences. 2001;5(3):10-3.
6. Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and post-anaesthetic shivering. British Journal of Anaesthesia. 2000 May 1;84(5):615-28.
7. Cattabriga I, Pacini D, Lamazza G, Talarico F, Di Bartolomeo R, Grillone G, et al. Intravenous paracetamol as adjunctive treatment for postoperative pain after cardiac surgery: a double blind randomized controlled trial. European Journal of Cardio-thoracic surgery. 2007 Sep 1;32(3):527-31.
8. Baldini A, Von Korff M, Lin EH. A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. The primary care companion to CNS disorders. 2012;14(3).
9. Howie WO, McMullen PC. Breastfeeding problems following anesthetic administration. The Journal of perinatal education. 2006;15(3):50.
10. Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesthesia & Analgesia. 2005 Nov 1;101(5S):S62-9.
11. Banik D, Hye MA, Akhtaruzzaman AK, Aziz L, Yeasmeen S, Iqbal KM. Effect of small dose intermittent IV pethidine in combination with diclofenac for postoperative pain relief. JOURNAL OF THE BANGLADESH SOCIETY. 2009 Jul;22(2):84.
12. Barkhori A, Drodian MR, Norozi M, Hashemi Shadmehri M, Shabani M. A comparative study of the effect of diclofenac, indomethacin, naproxen, and acetaminophen rectal suppositories on post-cesarean pain. Journal of Birjand University of Medical Sciences. 2014;20(4):338-45.
13. Irer B, Gulcu A, Aslan G, Goktay Y, Celebi I. Diclofenac suppository administration in conjunction with lidocaine gel during transrectal ultrasound-guided prostate biopsy: prospective, randomized, placebo-controlled study. Urology. 2005 Oct 1;66(4):799-802.
14. Ragavan N, Philip J, Balasubramanian SP, Desouza J, Marr C, Javle P. A randomized, controlled trial comparing lidocaine periprostatic nerve block, diclofenac suppository and both for transrectal ultrasound guided biopsy of prostate. The Journal of urology. 2005 Aug 1;174(2):510-3.
15. Haq A, Patel HR, Habib MR, Donaldson PJ, Parry JR. Diclofenac suppository analgesia for transrectal ultrasound guided biopsies of the prostate: a double-blind, randomized controlled trial. The Journal of urology. 2004 Apr 1;171(4):1489-91.
16. Siddik SM, Aouad MT, Jalbout MI, Rizk LB, Kamar GH, Baraka AS. Diclofenac and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine. Regional anesthesia and pain medicine. 2001 Jul 1;26(4):310-5.
17. Rashid M, Jaruidi HM. The use of rectal diclofenac for post-cesarean analgesia. Saudi medical journal. 2000;21(2):145-9.
18. Ng A, Parker J, Toogood L, Cotton BR, Smith G. Does the opioid‐sparing effect of rectal diclofenac foll1owing total abdominal hysterectomy benefit the patient?. British journal of anaesthesia. 2002 May 1;88(5):714-6.
19. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. British journal of anaesthesia. 2005 Jan 28;94(4):505-13.
20. Smith HS. Potential analgesic mechanisms of acetaminophen. Pain physician. 2009 Jan 1;12(1):269-80.
21. Graham GG, Scott KF. Mechanism of action of paracetamol. American journal of therapeutics. 2005 Jan 1;12(1):46-55.
22. Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Current Opinion in Anesthesiology. 2006 Oct 1;19(5):562-5.
23. Myles PS, Power I. Clinical update: postoperative analgesia. The Lancet. 2007 Mar 10;369(9564):810-2.
24. Fox ER, Jones VM, Beckwith MC. Acetaminophen Injection: A Review of Clinical Information Including Forms Not Available in the United States. Journal of pain & palliative care pharmacotherapy. 2012 Jun 22;26(2):115-7.
25. Katz J, Melzack R. The McGill Pain Questionnaire: Development, psychometric properties, and usefulness of the long-form, short-form, and short-form-2 [Internet]. Guilford Press; 2011 [cited 2018 Jun 20]. 22 p. Available from https://yorkspace.library.yorku.ca/xmlui/handle/10315/18737
26. Iohom G, Walsh M, Higgins G, Shorten G. Effect of perioperative administration of dexketoprofen on opioid requirements and inflammatory response following elective hip arthroplasty. British journal of anaesthesia. 2002 Apr 1;88(4):520-6.
27. Metz SA. Anti-inflammatory agents as inhibitors of prostaglandin synthesis in man. Medical Clinics of North America. 1981 Jul 1;65(4):713-57.
28. Joshi Vyankatesh S, Vyavahare Ramesh D, Khade Ganesh DS, Jamadar NP. Comparative study of analgesic efficacy of rectal suppository of tramadol versus diclofenac in suppressing postoperative pain after cesarean section. Int J Health Care Biomed Res. 2013 Jan;1(2):32-7.
29. Ebrahim AJ, Mozaffar R, Nadia BH, Ali J. Early postoperative relief of pain and shivering using diclofenac suppository versus intravenous pethidine in spinal anesthesia. Journal of anaesthesiology, clinical pharmacology. 2014 Apr;30(2):243.
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