Comparative study of diclofenac suppository with tramadol suppository in addition to acetaminophen for post caesarian analgesia
Keywords:Caesarean section, Diclofenac, Multimodal, Pain, Tramadol
Background: Pain after emergency and elective caesarean section may adversely affect patient’s recovery and breastfeeding initiation. The aim of present study was to compare the analgesic efficacy of diclofenac suppository-intravenous acetaminophen (APAP) combination, tramadol suppository-intravenous APAP combination and intravenous APAP alone for postoperative pain relief after caesarean section.
Methods: We designed a randomized double-blind control study. Three hundred parturient scheduled for caesarean section were randomized to receive diclofenac rectal suppository (100 mg), tramadol rectal suppository (100 mg) or glycerin rectal suppository in Group A, B and C respectively (100 parturient in each group). All the women routinely received 1000 mg acetaminophen intravenously. Assessment of pain was done using a visual analogue scale (VAS) at 0, 1, 6, 12, 18 and 24 hours. injection Pentazocine 0.3 mg/kg IV was given as rescue analgesia when VAS score > 30.
Results: The mean VAS score was significantly higher in Group C as compared to Group A and Group B (p value < 0.001). This suggests better efficacy of multimodal treatment as compared to monotherapy. Group A as compared to Group B showed better efficacy in term of VAS score at 12 and 18 hours (p = 0.05, p = 0.02 respectively).
Conclusions: We found that when controlling for socio-demographic characteristics, combination of either diclofenac or tramadol suppository with acetaminophen has significantly better results when compared with monotherapy of acetaminophen alone in post-operative analgesia after caesarean section. However, the combination of diclofenac suppository has proved to be superior in comparison to tramadol suppository.
Pereira S, Portela F, Santos M, Machado J, Abelha A. Predicting type of delivery by identification of obstetric risk factors through data mining. Procedia Comput Sci. 2015;64:601-9.
Appropriate technology for birth. Lancet. 1985;2(8452):436-7.
Verstraete S, Van deVM. Post-cesarean section analgesia. Acta Anaesthesiol Belg. 2012;63:147-67.
Harper CM, Lyles UM. Physiology and complication after bed rest. J Am Geriatr Soc. 1988;36:1047-54.
Kehlet H, Dahl JB. The value of ‘multimodal’ or ‘balanced analgesia’ in postoperative pain treatment. Anesth Analg. 1993;77:1048-56.
Chan A, Dore CJ, Ramachandra V. Analgesia for day surgery. Evaluation of the effect of diclofenac given before or after surgery with or without bupivacaine inﬁltration. J Anaesth. 1996;51:592-5.
Munishankar B, Fettes P, Moore C, Mcleod GA. Adouble-blind randomized controlled trial of paracetamol, diclofenac or the combination for pain relief after cesarean section. Int J Obstet Anaesth. 2008;17:9-14.
Booth JL, Harris LC, Eisenach JC, Peter H. A randomized controlled trial comparing two multimodal analgesic techniques in patients predicted to have severe pain after cesarean delivery. Anesth Analg. 2016;122:1114-9.
Merrikhihaghi S, Farshchi A, Farshchi B, Farshchi S, Dorkoosh FA. Tramadol versus Diclofenac in pain management after cesarean section: a cost analysis study. J Pharm Pharm Sci. 2015;1(1):22-4.
Heidar D, Behrouz MA, Shali SMK, Tajik A. Analgesic efficacy of Diclofenac and Paracetamol vs Meperidine in cesarean section. Anesth Pain Med. 2014;4:e9997.
Taneja A, Kaur T, Sood IV. Comparative study on the effect of Paracetamol, Diclofenac and their Combination in post operative pain relief of cesarean section. J K Sci. 2015;17:30-2.
Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with non-steroidal anti-inflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010;110:1170-79.
Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs, or their combination in postoperative pain management: a qualitative review. Br J Anaesth. 2002;88:199-214.