Comparison of analgesic efficacy of diclofenac suppository with intramuscular diclofenac sodium in post-operative pain relief after cesarean delivery in the first 24 hours
Authors: Khan Sidra , Majeed Noreen , Ruqya  , Mehdi Mehreen , Safdar Faiza , Bibj Saana 
Published: July 2023

Background
About 80% of the patients experience enough post-operative pain to require analgesia. Adequate pain relief is needed after caesarean section to assist ambulation , mother / baby bonding & above all, a pleasant experience of being a mother. Different analgesics with various routes of administrations are available for pain relief which include opioids and NSAIDS. Opiods are known for their undesireable side effects . Diclofenac sodium is an NSAID & acts via blocking prostaglandin production. The WHO recommends diclofenac as a first line drug in pain relief. It is available in various preparations which include injections, tablets and suppositories.
We compared the mean pain experienced by the women after use of diclofenac suppositories and intramuscular diclofenac sodium after elective cesarean section in first 24 hours.
Methodology
This RCT was done in the department of Obstetrics and Gynecology, --removed for blind review---from 1st March 2018 till 30th August 2018. Total of 100 antenatal women already planned for elective caesarean section ,who fulfilled inclusion criteria were selected after taking informed consent & ethical approval by employing non probability consecutive sampling . The age , parity ,gestational age, weight ,BMI & ASA status of all women was documented. 50 women were randomly assigned to the each group A & B. Group A was given 75 mg intramuscular diclofenac injection immediately & then 8 hrly for the first 24 hrs after caesarean section while group B was given 100 mg rectal diclofenac suppository immediately & then after 12 hrs post caesarean for the first 24 hrs. if needed ,50 mg tramadol I/V was given to the women as rescue analgesia, Visual analogue pain (VAS) score was used to assess the pain intensity of post operative women after 24 hrs of caesarean and poltted in the proforma. The number of women needing rescue analgesia in each group was also documented. & compared between the two groups.
RESULTS:
Data was analyzed on the SPSS version 23. In group A; mean age was 26.34 years with STD of 3.69. Mean gestational age was 37.82 weeks with STD of 1.79. In group B; mean age was 25.3 years with STD of 3.47. Mean gestational age was 37.70 weeks with STD of 1.59. In group A; mean weight was 84.62 kgs with STD of 5.76 and mean BMI was 32.18 with STD of 3.16. In group B; mean weight was 84.84 kgs with STD of 7.27 and mean BMI was 31.13 with STD of 3.57. In group A (intramuscular diclofenic injection group) the mean score of pain was 3.72 with STD of 0.57. In group B (Diclofenic Suppository Group) the mean score of pain was 1.84 with STD of 0.68. P-value was significant. 26 women (52%) in group A (I/M diclofenac group) and 20 women (40%) in group B (rectal diclofenac suppository group) needed rescue analgesia with I/V Tramadol .P value was not significant.

CONCLUSION:
Dicolofenac is an effective post caesarean analgesic . Rectal route of diclofenac is more effective than the intramuscular route as post caesarean analgesia . Almost less than half number of post caesarean women needed rescue analgesia after using diclofenac suppository .