Management of Postcaesarean Delivery Analgesia-Diclofenac Suppository, Paracetamol Infusion and a Combination

Abstract

Introduction: One of the most important aspect of postoperative care is pain management which plays an important role in early recovery and improves patient’s general condition. Paracetamol and diclofenac have an excellent safety profile when compared to opioids. Aim: To assess and compare the analgesic efficacy and safety of individual use of Intravenous (IV) paracetamol, diclofenac suppository and in combination. Materials and Methods: This hospital-based cross-sectional study was conducted from October 2018 to June 2020 at Department of Obstetrics and Gynaecology. A total of 90 women who underwent caesarean section were recruited for the study and were randomly allocated (lottery method) into three groups with 30 participants in each group. The patients underwent Lower Segment Caesarean Section (LSCS) under spinal anaesthesia with the same technique and medicine, (Bupivacaine 0.5%) without receiving any sedation. Group A patients received diclofenac suppository 50 mg every eight hourly, Group B received paracetamol infusion 1000 mg every eight hourly and Group C received 50 mg diclofenac suppository and 500 mg IV paracetamol every eight hourly. Pain severity (Visual Analogue Scale (VAS) score), Heart Rate (HR), Blood Pressure (BP) and side-effects were evaluated at 2,4,6,8,12 and 24 hours postoperatively. Patient satisfaction score was evaluated 24 hours after caesarean section. Results: Age range of participants was 19 to 28 years. Mean duration of surgery (minutes) in each group were- Group A-56.5±7.49, Group B-58.27±8.06 and Group C-56.97±6.78, respectively. There was a significant reduction of pain in patients receiving paracetamol and diclofenac suppository combination group. The satisfaction score was categorised as excellent by 80% patients in Group C. In Group A 30% and in Group B 16.6% categorised as excellent patient satisfaction score. The adverse effects such as nausea and epigastric discomfort was higher (7.7%) with diclofenac suppository group followed by Paracetamol (2.2% side-effects) and minimal with combination (1%). Conclusion: Paracetamol infusion is as effective as diclofenac suppository in reducing postoperative pain following caesarean section. Diclofenac suppository and IV paracetamol combination provides more effective postoperative analgesia compared with individual usage of IV paracetamol or diclofenac suppository in patients following caesarean section. The combined use of paracetamol and diclofenac suppository has fewer side-effects compared with individual use of either IV paracetamol or diclofenac suppository.