Single dose diclofenac suppository reduces post-Cesarean PCEA requirements

Area of Science:

• Anesthesiology
• Pharmacology
• Obstetrics

Background:

• Post-Cesarean section pain management is crucial for recovery.
• Patient-controlled epidural analgesia (PCEA) is commonly used for post-Cesarean pain relief.
• Non-opioid adjuncts can potentially reduce opioid and local anesthetic requirements.

Purpose of the Study:

• To evaluate the analgesic efficacy of a single 100 mg diclofenac suppository administered immediately after lower segment Cesarean section (LSCS).
• To assess the impact of diclofenac on patient-controlled epidural analgesia (PCEA) requirements in the post-operative period.

Main Methods:

• Randomized, double-blind study involving 48 parturients undergoing elective LSCS under combined spinal-epidural anesthesia.
• PCEA was initiated post-operatively with ropivacaine and fentanyl.
• Patients received either a 100 mg diclofenac suppository or placebo immediately after surgery.
• Pain scores, sensory and motor blockade, and local anesthetic consumption were assessed at 1, 6, 12, and 24 hours post-operatively.

Main Results:

• Patients receiving diclofenac used significantly less local anesthetic mixture (52.8 mL) compared to the control group (74 mL) (P < 0.005).
• There were no significant differences in pain scores or patient satisfaction between the diclofenac and placebo groups.
• Diclofenac reduced post-operative epidural local anesthetic requirements by 33%.

Conclusions:

• A single 100 mg diclofenac suppository effectively reduces local anesthetic consumption in PCEA for post-Cesarean section analgesia.
• Diclofenac can be a valuable adjunct for managing post-LSCS pain and reducing reliance on epidural infusions.
• Further research may explore optimal timing and dosage for diclofenac in post-Cesarean pain management.