Comparative Effects of Single Agent Rectal Diclofenac versus a Combination of Rectal Diclofenac and Intramuscular Pentazocine, on Post Caesarean Section Pain Relief in a Tertiary Institution in Southern Nigeria

Abstract

Background: Caesarean section commonly causes moderate to severe pain in the first 24 hours after surgery with associated discomfort, delayed ambulation, difficulty initiating breastfeeding and prolonged hospital stay. Receiving adequate analgesia after caesarean section is very important for the patient’s comfort, overall wellbeing and recovery.
 Objective: To compare the efficacy, time to rescue-analgesia and side effects of single agent rectal diclofenac versus its combination with intramuscular pentazocine for pain management after caesarean section in Rivers State University Teaching Hospital (RSUTH).
 Methodology: A randomized double-blind clinical trial was carried out at the RSUTH. A total of 120 patients scheduled for either elective or emergency caesarean section were recruited. Group ‘A’ received rectal diclofenac 100 mg and intramuscular placebo (unimodal group) while group ‘B’ received rectal diclofenac 100mg and intramuscular pentazocine 30 mg (multimodal group). Socio-demographic information was collected via structured proforma, while Visual Analog Scale (VAS) was used to assess the level of pain. Data were analyzed using SPSS version 20 and statistical significance was set at p < 0.05.
 Results: The mean ages of respondents in unimodal and multimodal groups were 31.7 ± 4.3 years and 31.3 ± 5.2 years respectively. The difference in the median pain score and range was significant only at 8 hours between the groups, there was no significant difference before and after 8 hours. Although the mean time (in minutes) to first rescue-analgesia was shorter in the unimodal (147.5 ± 60.1) as compared to the multimodal group (170.0), this difference was not statistically significant. There was no side effect noticed in either of the two groups.
 Conclusion: The combined agents (diclofenac and pentazocine) had a superior analgesic effect to the single agent (diclofenac alone) when given as used in the study.

Diclofenac-Tramadol Versus Diclofenac-Acetaminophen Combination for Post Caesarean Section Pain Control: A Randomized Controlled Trial

“…This showed that that the socio-demographic variables were evenly distributed between the two groups and this eliminated any possible confounding influence from them. This was similar to reviewed studies with similar drug combination [20,22,51,52] .…”

“…This is similar to study by Adeniji et al [20] who noted that the use of PP or TP had better satisfaction that pentazocin or tramadol alone. Also, both Kwosah et al [52] and Egede et al [51] recorded good maternal satisfaction when bimodal agents were used compared to unimodal agent as was seen in our study were we used bimodal agents, though both unimodal agents and pentazocine were not considered in our study. However, Mitra et al [22] did not study the level of maternal satisfaction and this was one of the gaps noted justifying the reason for our study.…”

“…This could be that the antiemetic they used ondansentron, is known to be more potent that metoclopramide used in our study. When compared with studies by Kwosah et al [52] and Egede et al [51] , there were higher side effect of dizziness. This maybe the presence of pentazocine used in these studies unlike ours.…”

“…The mean pain score association between the type of caesarean section and mean pain score at rest and with movement between both groups was similar. Kwosah et al [52] , Egede et al [51] and Mitra et al [22] did not compare using the type of caesarean section. This was another area of knowledge gap noted which this study answered.…”

Pentazocine with rectal diclofenac versus pentazocine alone for pain relief following caesarean delivery in Enugu, Nigeria: A randomized controlled trial

“…12,13 These current findings were similar to those of previous reports that suggested that the use of multimodal analgesia gives better pain relief than unimodal analgesia. 29,30 It should be noted that the level of pain perception in the first hour after surgery was not significantly different between the two groups. This could be due to the variable duration of spinal anaesthesia that was used in the patients, the varying length of time used to complete the surgery and the fixed time in which the drugs were commenced on both groups (1 h after surgery), However, after commencement of the drugs in both groups, the difference in pain perception became significantly between the two groups.…”