Abstract
Background: Managing postoperative pain after cesarean section is imperative, as acute postoperative pain is considered a risk factor for chronic postoperativepain. We investigatedthe role of diclofenac suppositories in postoperative pain management after cesarean section.
Methods: For this systematic review, we searched PubMed, Scopus, the Cochrane Library, Google Scholar, and two other clinical trial registers from database inception up to July 23 to July 26, 2024. We included randomized controlled trials and other studies in whichdiclofenac suppositories were administeredas an intentional intervention. We excluded studies not reported in English and without a focus on the principal medicine (diclofenac suppository). Two researchers independently selected studies and evaluated the risk of bias with RoB-2 according to PRISMA-2020 guidelines. Primary outcomes included pain severity or intensity measured with validated clinical scales. We synthesized the studies narratively.
Findings: From 203 records, we selected 16 studies. Discrepancies in the study design or its reporting were observed. The visual analogue scale (VAS) is a frequently used pain assessment tool. Diclofenac suppositories were compared under three broad categories: placebo, other nonsteroidalanti-inflammatory drugs (NSAIDs), opioids andopioid-like medicines. The combination of pain medicines (multimodal analgesia) was central to most ofthe studies; however, heterogeneity and risk of bias undermine the reliability of these findings.
Interpretation: The combination of diclofenac suppositories with other NSAIDs, which are usually opioids such as morphine, meperidine or pentazocine, reduces the need for rescue pain medicines.