Post-Operative Analgesia with Preventive and Post-Operative Rectal Diclofenac in Patients undergoing Caesarean Section Under Spinal Anesthesia: A Comparative Study

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Background and aims: To study the analgesic efficacy of preventive rectal Diclofenac in comparison to post-operative rectal Diclofenac in elective caesarean section surgeries. Methodology: After obtaining approval from institution ethics committee, patients undergoing elective caesarean section under spinal anesthesia were included in the study and divided into two groups ED(Early Diclofenac) & LD(Late Diclofenac), differing in the time of administration of first dose of 100mg rectal Diclofenac. Pain scores were noted at 12 & 24 hours post administration of first dose of rectal Diclofenac, using the numerical rating score. Rescue analgesia was given in form of Tramadol infusion. Time to first rescue analgesia, postoperative pain scores at 12& 24 hours, cumulative opioid requirements and side effects if any were noted. Results: We observed a statistically significant difference in the time to first rescue analgesia between the two groups. There was no statistically significant difference in the average pain scores, cumulative opioid requirements and side effects between the two groups. Conclusion: Rectal Diclofenac is an effective modality for treatment of postoperative pain after caesarean section. Preventive rectal Diclofenac, in comparison to postoperative Diclofenac significantly prolongs the duration to first rescue analgesia. The two groups did not differ significantly in the cumulative opioid consumption at 24 hours. There was no statistically significant difference in pain scores at 12 and 24 hours between the two groups. The average pain scores in both groups were around 3/10.

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