Comparison of the Effectiveness of Per-Rectal Diclofenac Sodium Vs Parenteral Diclofenac Sodium for Postoperative Analgesia
DOI:
https://doi.org/10.70749/ijbr.v3i6.2811Keywords:
Cesarean Section, Diclofenac Sodium, Per-rectal Analgesia, Intramuscular Analgesia, Rescue Analgesia, Visual Analogue Score.Abstract
Background: Postoperative pain after cesarean section remains a frequent clinical concern and may delay mobilization and recovery. Nonsteroidal anti-inflammatory drugs such as diclofenac sodium are commonly used, but the optimal route of administration for effective analgesia and reduced need for rescue medication remains debated. Aim: To compare the effectiveness of per-rectal diclofenac sodium versus intramuscular diclofenac sodium for postoperative analgesia after cesarean section. Materials and Methods: A randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, National Hospital Lahore, from November 2024 to April 2025. A total of 274 primigravida women (137 per group), aged 18 to 35 years, with singleton pregnancies and ASA physical status I or II undergoing cesarean section under spinal anesthesia were enrolled through non-probability consecutive sampling. Group A received intramuscular diclofenac sodium 75 mg twice daily for 24 hours, while Group B received per-rectal diclofenac suppository 100 mg twice daily. Primary outcome was the requirement of rescue analgesia within 24 hours. Secondary outcomes included Visual Analogue Score at 24 hours and time to rescue analgesia. Data were analyzed using chi-square and independent sample t-tests. Results: Mean maternal age was 26.42 ± 4.18 years in Group A and 25.87 ± 4.32 years in Group B (p = 0.31). Mean gestational age was 38.16 ± 1.52 versus 38.34 ± 1.48 weeks (p = 0.34), and mean body mass index was 27.63 ± 3.41 versus 27.28 ± 3.56 kg/m² (p = 0.43). Rescue analgesia was required in 79 participants (57.66%) in Group A and 58 participants (42.34%) in Group B (p = 0.011). Mean 24-hour VAS score was 4.53 ± 1.82 in Group A and 3.76 ± 1.96 in Group B (p = 0.001). Time to rescue analgesia was 3.87 ± 2.46 hours versus 4.52 ± 2.71 hours (p = 0.14). Conclusion: Per-rectal diclofenac sodium achieved better postoperative pain control and reduced reliance on rescue analgesia compared to intramuscular diclofenac sodium after cesarean section.
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