Comparative study of diclofenac, paracetamol infusion, or a combination in post-caesarean patients for pain management

Abhilasha Choudhary; Swati; Pahula Verma

doi:10.18203/2320-1770.ijrcog20240799

Authors

Abhilasha Choudhary Department of Obstetrics and Gynecology, N.C. Medical College, Israna, Panipat, Haryana, India
Swati Department of Obstetrics and Gynecology, N.C. Medical College, Israna, Panipat, Haryana, India
Pahula Verma Department of Obstetrics and Gynecology, N.C. Medical College, Israna, Panipat, Haryana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20240799

Keywords:

Diclofenac, Paracetamol, Post-operative pain, Caesarean patient, VAS score

Abstract

Background: The World Health Organization (WHO) has released fresh information showing that the number of caesarean sections performed worldwide has increased and now accounts for more than one in five (21%) deliveries. 89.8% of women experienced significant post-operative discomfort following a caesarean section and 84.2% reported to have moderate to severe pain. This study aimed to compare diclofenac, paracetamol infusion, and a combination of both in patients of post-caesarean for pain management.

Methods: The study was a cross-sectional study carried out in the department of obstetrics and gynaecology at a tertiary care hospital in a rural area of Panipat, Haryana. A total number of 102 women who underwent caesarean section were taken for the study. They were divided into 3 groups each having 34 women. The first group was given diclofenac, the second was given paracetamol infusion and the third was given a combination of both for pain management.

Results: In our study we have done visual analog score (VAS) scoring at 0, 1, 6, 12, 18 and 24 hours and we found that the mean VAS score in group 3 was highest when compared to other two groups. We also found that on comparing data of VAS score between the three groups the p value came out to significant that is p≤0.001.

Conclusions: We found that combination therapy had good results in comparison to individual therapy and had fewer side effects.

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References

World Health Organization. Caesarean section rates continue to rise, amid growing inequalities in access. WHO report 2021. Available at: https://www. who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access#:~:text=Rising%20rates%20suggest%20increasing%20numbers%20of%20medically%20unnecessary%2C%20potentially%20harmful%20procedures&text=According%20to%20new%20research%20from,21%25)%20of%20all%20childbirths. Accessed on 12 November 2023.

Appropriate technology for birth. Lancet. 1985;2(8452):436-7.

Demelash G, Berhe YW, Gebregzi AH, Cheko WB. Prevalence and factors associated with postoperative pain after cesarean section at a comprehensive specialized hospital in Northwest Ethiopia: a prospective observational study. Open Access Surg. 2022;15:1.

Admassu WS, Hailekiros AG, Abdissa ZD. Severity and risk factors of postoperative pain in University of Gondar Hospital, Northeast Ethiopia. J Anesth Clin Res. 2016;7(10):675.

Barash PCBF, Stoelting Robert K, Cahalan Michael K, Stock Christine M. Lippincott Williams & Wilkins; Philadelphia. Clinical Anesthesia. 2009.

Hussen I, Worku M, Geleta D, Mahamed AA, Abebe M, Molla W, et al. Post-operative pain and associated factors after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study. Ann Med Surg (Lond). 2022;81:104321.

Stephens JLB, Pashos C, Pena B, Wong J. The burden of acute postoperative pain and the potential role of the COX-2-specific inhibitors. Rheumatology. 2003;1(42):40-52.

Lin CC. Applying the American Pain Society's QA standards to evaluate the quality of pain management among surgical, oncology, and hospice in patients in Taiwan. Pain. 2000;87(1):43-9.

Klopper HAH, Minkkinen M, Ohlsson C, Sjostrom B. Strategies in assessing post- operative pain—a South African study. Intens Crit Care Nurs. 2006;22(1):12-21.

Shen QSG, McNeill JA, Li Z. Postoperative pain management outcome in Chinese inpatients. West J Nurs Res. 2008;30(8):975-90.

Verstraete S, Van deVM. Post-cesarean section analgesia. Acta Anaesthesiol Belg. 2012;63:147-67.

Wickerts L, Warren M, Brattwall M, Jakobsson J. Is there a benefit when compared to traditional non-selective NSAIDs in postoperative pain management? Minerva Anaesthesiol. 2011;77:1084-98.

Vadivelu N, Mitra S, Narayan D. Recent advances in Postoperative Pain Management. Yale J Biol Med. 2010;83(1):11-25.

James A, Williams J. Basic opioid pharmacology update. British J Pain. 2020;14:115- 21.

Schreijenberg M, Luijsterburg PA, Van Trier YD, Rizopoulos D, Koopmanschap MA, Voogt L, et al. Efficacy of paracetamol, diclofenac and advice for acute low back pain in general practice: Design of a randomized controlled trial (PACE Plus). BMC Musculoskelet Disord. 2017;18:56.

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;66(4):799-802.

Ragavan N, Philip J, Balasubramanian S, 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 the prostate. J Urol. 2005;174(2):510-3.

Ng A, Parker J, Toogood L, Cotton B, Smith G. Does the opioid-sparing effect of rectal diclofenac following total abdominal hysterectomy benefit the patient? Br J Anaesth. 2002;88(5):714-6.

McLaren S, Hughes M, Sheehan C, Sokhi J. A guide to epidural management. Br J Hosp Med (Lond). 2020;81(1):1-7.

Ezeonu PO, Anozie OB, Onu FA, Esike CU, Mamah JE, Lawani LO, et al. Perceptions and practice of epidural analgesia among women attending antenatal clinic in FETHA. Int J Womens Health. 2017;9:905-11.

Tai FWD, McAlindon ME. Non-steroidal anti-inflammatory drugs and the gastrointestinal tract. Clin Med (Lond). 2021;21(2):131-4.

Akhavanakbari G, Entezariasl M, Isazadehfar K, Kahnamoyiagdam F. The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioid consumption after cesarean section. Perspect Clin Res. 2013;4:136.

Reddy MS, Munisamaiah M. Management of Postcaesarean Delivery Analgesia- Diclofenac Suppository, Paracetamol Infusion and a Combination. J Clin Diag Res. 2021;15(9):QC05-8.

Munishankar B, Fettes P, Moore C, McLeod G. A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. Int J Obstet Anesth. 2008;17:09-14.