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

Abstract

Background & Aim: Perineal pain can be caused by surgical (episiotomy) and spontaneous trauma and lacerations after vaginal birth. Episiotomies represent one form of trauma and are equivalent to a second-degree laceration that affects the mucosa and perineal muscles. Generally, there are many methods for treatment of such pain either with pharmacological agents or non-pharmacological agents. This study aimed to compare between rectal versus oral diclofenac sodium in relieving post episiotomy pain. Materials and Methods: A total of 184 women underwent episiotomy were enrolled in the study. Those women were randomly subdivided intro rectal group where women received 100 mg rectal diclofenac sodium and oral group where women received 100 mg oral diclofenac sodium. Need to rescue analgesia, visual analogue scale and patient's satisfaction were recorded. Results: Both groups had insignificant difference as regard baseline data. But it was found that rectal group had low frequency of rescue analgesia (1.1% vs. 8.7%; p= 0.01), lower visual analogue scale at different time of assessment up to 24-hour after repair (p< 0.001), no side effects and better satisfaction in comparison to the oral group. In this study, a total of 25 (27.2%) women in the oral different side effects in form of epigastric pain and vomiting. Conclusion: Rectal diclofenac had better analgesic effects and minor upper gastrointestinal adverse effects were less frequently reported for post-perineal repair pain after episiotomy. Similar studies are needed among larger population and in different geopolitical zones to confirm any link to regional or ethnic variation.