A randomized controlled trial of rectal analgesia diclofenac sodium for relief of perineal pain following child birth

Abstract

Objectives: To evaluate rectal diclofenac sodium in the relief of perineal pain after trauma during childbirth.Design: A randomized , double blind trial. Setting:The obstetric department (ward 21) , Professorial Unit, Colombo South Teaching Hospital, Kalubowila.Population: Women with an episiotomy or any degree of perineal tears including vestibular tears, which required suturing.Method: Women were randomly allocated to either diclofenac sodium or placebo suppositories (Anusol) , using a random -number table. Treatment packs contained two, diclofenac sodium 100 mg and diclofenac sodium 50 mg suppositories or two placebo suppositories, The first (diclofenac sodium100mg or placebo) was inserted when suturing was completed , and the second (50 mg diclofenac sodium or placebo) 12 hours after birth. Women were asked to indicate their degree of perineal pain at 24 hours after birth, using 10 cm visual analogue scale. Main outcome measure: Pain score at 24 hours after birth.Results: A total of 169 women were recruited, with 84 randomized to diclofenac sodium suppositories and 85 to placebo. Women in the diclofenac sodium group were significantly less likely to experience pain within 24 hours of delivery (percentage of mean pain score reduction , 45% , P < .001 ) compared with those who received placebo. Conclusions:The use of rectal diclofenac sodium is a simple and effective method of reducing the pain experienced by women following perineal trauma within the first 24 hours after childbirth.

Rectal versus Oral Diclofenac Sodium in Relieving Post-Episiotomy Pain: Randomized Controlled Study

“…The summary of the pain scores in the first 24 hourspost-repair shows that the overall pain perception in both group of analgesia was in the mild and moderate severity range. This confirmed similar studies which revealed that diclofenac is an effective analgesia for the control of post perineorrhaphy perineal pain [8,13,14] .…”

“…Pain scores were significantly lower in diclofenac group (rectal group) when compared to mefenamic acid group (oral group) [9] . Also, another study reported that diclofenac sodium suppositories group were significantly less likely to experience pain within 24 hours of delivery (percentage of mean pain score reduction, 45%, P < .001) compared with those who received placebo [8] . Nafees et al found that overall pain score was significantly lower immediately and 6 hours after repair in women received diclofenac sodium as rectal suppositories compared to intramuscular injection [13] .…”

“…Rectal diclofenac sodium is an effective, cheep, widely available and safe analgesic agent for pain relief. Studies assessing the efficacy of rectal analgesics in postoperative pain relief have indicated significant reduction of pain experienced, and reduced requirement of additional analgesia [8,9] .…”