Intramuscular pentazocine versus rectal diclofenac for pain relief after caesarean section: a randomized controlled trial

Atongo T. Jesse; Ochima Onazi; Tunde-Olatunji Olubumi; Talimoh W. Dah

doi:10.18203/2320-1770.ijrcog20251553

Authors

Atongo T. Jesse Department of Obstetrics and Gynaecology, Federal medical centre Keffi, Nigeria
Ochima Onazi Department of Obstetrics and Gynaecology, Federal medical centre Keffi, Nigeria
Tunde-Olatunji Olubumi Department of Obstetrics and Gynaecology, Federal medical centre Keffi, Nigeria
Talimoh W. Dah Department of Obstetrics and Gynaecology, Federal medical centre Keffi, Nigeria

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20251553

Keywords:

Analgesia, Caesarean section, Maternal satisfaction, Pain, Side effects

Abstract

Background: Caesarean section (CS) commonly causes moderate to severe pain in the first 48 hours after surgery with associated discomfort, delayed ambulation, difficulty initiating breastfeeding and prolonged hospital stay. Adequate analgesia after caesarean section is very important for the patient’s comfort, overall wellbeing and recovery. This study compared the analgesic effectiveness of intramuscular Pentazocine with rectal diclofenac following caesarean section and also the side effects of these drugs in Federal Medical Centre, Keffi, North Central Nigeria.

Methods: It was an open label single blinded randomized controlled trial carried out among 240 eligible patients scheduled for either elective or emergency caesarean section. Participants were randomised in the ratio 1:1 to use either rectal diclofenac or intramuscular pentazocine. The effectiveness of the drugs on post caesarean section pain relief and maternal satisfaction were assessed using Visual Analog scale (VAS) and Likert's scale respectively. The side effects of the drugs were also assessed.

Results: Majority of the participants had mild to moderate pain throughout the 24 hours period of the study with most having moderate pain. There was no statistically significance difference in the effectiveness of the drugs among the two groups (p=0.745), however maternal satisfaction was higher with the rectal diclofenac group compared with the intramuscular pentazocine group (p=0.017).

Conclusions: This study showed that suppository diclofenac and intramuscular pentazocine are comparable in pain relief post caesarean section but there was better maternal satisfaction with suppository diclofenac use compared to intramuscular pentazocine use.

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References

Peter B, Maria Q, Sarah A, Elizabeth A, Ursula B. Caesarean section surgical techniques: A randomized factorial trial (CAESAR). BJOG. 2010;117:1366-76. DOI: https://doi.org/10.1111/j.1471-0528.2010.02686.x

Samina I, Gauhar A, Abdul M, Aliya A. Postoperative analgesia following caeserean section: intravenous patient-controlled analgesia versus conventional continuous infusion. Open J Anesthesiol. 2012;2(4):2912.

Bourne S, Machado AG, Nagel SJ. Basic anatomy and physiology of pain pathways. Neurosurg Clin N Am. 2014;25:629-38. DOI: https://doi.org/10.1016/j.nec.2014.06.001

Bamigboye AA, Hofmeyr JG. Caesarean section wound infiltration with local anaesthetic for postoperative pain relief any benefit. S Afr Med J. 2010;100:313-9. DOI: https://doi.org/10.7196/SAMJ.3716

Shahraki AD, Jabalameli M, Ghaedi S. Pain relief after Caesarean section: Oral methadone vs. intramuscular pethidine. Res Med Sci. 2012;17:143-7.

Adeniji AO, Atanda OO. Randomized comparison of effectiveness of unimodal opioid analgesia with multimodal analgesia in post caesarean section pain management. J Pain Res; 2013;6:419-24. DOI: https://doi.org/10.2147/JPR.S44819

Olateju SO, Adenekan AT, Olufolabi AJ, Owojuyigbe AM, Adetoye AO, Ajenifuja KO, et al. Pentazocine versus pentazocine with rectal diclofenac for postoperative pain relief after cesarean section-a double-blind randomized placebo-controlled trial in a low resource area. Middle East J Anaesthesiol. 2016;23(4):443-8.

Lakshmi PJ, Deepthi B, Rama RN. Rectal drug delivery: A promising route for enhancing drug absorption. Asian J Res Pharm Sci. 2012;2(4):143-9.

Olateju SOA, Adenekan AT, Fatungase OM, Sonaike MT. Awareness and use of Diclofenac Suppository for Postoperative Pain Relief by Nigerian Anaesthetists. Afr J Anaest Int C. 2012;12(2):45-8.

Uzoma O, Adeniyi A, Bakare A, Oremole O, Adewara E, Okere R, et al. Rectal versus intramuscular diclofenac sodium for pain relief following caesarean section a randomized control trial. JMSCR. 2018;6(8):624-30. DOI: https://doi.org/10.18535/jmscr/v6i8.103

Obi OL, Tukur J, Abdurrahman A, Salisu I. A randomized controlled trial of rectal diclofenac sodium and intramuscular pentazocine versus intramuscular pentazocine, diclofenac and paracetamol analgesics for pain relief in the first 48 hours after caesarean section. Trop J Obstet Gynaecol. 2020;37:101-7. DOI: https://doi.org/10.4103/TJOG.TJOG_1_20

Sapkai PS, Patil YD, Rajurkar SS. Use of rectal Diclofenac as an adjunct to spinal analgesia after caesarean section. Med Pulse Int J Anesthesiol. 2018;6(1):2579-900.

Zulfiqar M, Ashraf M, Khan MIH, Naeem F, Shakeel S. To compare efficacy of Diclofenac by intramuscular route and rectal route in post-surgical pain. Professional Med J. 2021;28(9):1269-75. DOI: https://doi.org/10.29309/TPMJ/2021.28.09.5885

Elliott R. Likert scale examples and definition. 2021;21:2022.

Onuorah CM, Fyneface-Ogan S, Aggo AT. The efficacy of diclofenac for post caesarean section analgesia: comparison of rectal and intramuscular routes. Nigerian J Med. 2018;27(3):278. DOI: https://doi.org/10.4103/1115-2613.278790

Rashid M, Jaruidi HM. The use of rectal diclofenac for post-cesarean analgesia. Saudi Med J. 2000;21(2):145-9.

Ebrahim AJ, Mozaffar R, Nadia BH, Ali J. Early post-operative relief of pain and shivering using diclofenac suppository versus intravenous pethidine in spinal anesthesia. J Anaesthesiol Clin Pharmacol. 2014;30(2):243-7. DOI: https://doi.org/10.4103/0970-9185.130038

Rita D, Ujwala P, Pavithra K. Effect of injectable tramadol v/s diclofenac suppository in post-operative gynaecological patients. Int J Clin Obst Gynaecol. 2022;6(2):75-8. DOI: https://doi.org/10.33545/gynae.2022.v6.i2b.1164

Khan S, Majeed N, Ruqya A, Mehdi M, Safdar F, Bibj S. Comparison of analgesic efficacy of diclofenac suppository with intramuscular diclofenac in post-operative pain relief after caesarean delivery in the first 24 hours. JRMC. 2022;26(4):642-8. DOI: https://doi.org/10.37939/jrmc.v26i4.1994

Altaf B, Kashif S, Sial SS, Noreen H, Pervaiz E, Awan MS. Comparison of intramuscular versus rectal diclofenac sodium in post caesarean pain relief. Pak Armed Forces Med J. 2022;72(6):1982-5. DOI: https://doi.org/10.51253/pafmj.v72i6.7153