Intramuscular diclofenac for analgesia after cesarean delivery: a randomized controlled trial

To evaluate the effectiveness of intramuscular diclofenac in postoperative cesarean section pain control.

A randomized controlled trial.

Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital.

Eighty patients scheduled for elective cesarean section between October 2007 and April 2008.

All patients had cesarean section performed under spinal anesthesia with spinal morphine and randomized into two groups by a table of randomization. They were to receive diclofenac 75 mg intramuscular every 12 hours for 2 doses or standard rescue drugs (Tramadol).

The number of patients who required rescue drugs, pain score (VAS), side effects of diclofenac, and satisfaction were evaluated for 48 hours postoperatively.

In the diclofenac group, no patient required rescue drug compared to 20% of patients in the control group (p < 0.05). Median pain scores were less in the diclofenac group at 6 hours (1 (range 0-6) vs. 4 (range 0-6), p = 0.002), 12 hours (2 (range 0-5) vs. 3 (range 0-7), p = 0.031), and 24 hours (1.5 (range 0-4) vs. 3 (range 1-8), p < 0.0001), respectively. No side effects of diclofenac (e.g., gastrointestinal bleeding, bleeding tendency, uterine atony, or injection site irritation) were observed Satisfaction was comparable in both groups.

Diclofenac can be used safely to reduce the requirement of rescue drugs for pain control in postoperative cesarean section.