The Impact of Diclofenac Suppositories on Post-Cesarean Section Pain: A Systematic Literature Review

Background: Managing postoperative pain after Cesarean section is imperative, as acute postoperative pain is considered a risk factor for chronic postoperative pain. We investigated the 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 which diclofenac suppositories were administered as an intentional intervention. We excluded studies not reported in English and without a focus on the principal medicine (diclofenac suppository). Two researchers independently chose studies and assessed the risk of bias using RoB-2, following the PRISMA-2020 guidelines. Primary outcomes included pain severity or intensity measured with validated clinical scales. We synthesized the studies narratively. The PICO was used to generate the research question: Population-Cesarean section patients, Intervention-diclofenac suppository, Comparison-opioids, Outcome-lower pain scores and a reduced need for more pain medications, Research question-the effectiveness of diclofenac suppositories in preventing postoperative pain and reducing the consumption of pain medicines in Cesarean section patients. Findings: From an initial pool of 203 records, 20 records were selected for review. Notably, discrepancies in the study design and reporting were observed. This raised concerns about the consistency and reliability of the results obtained from the different studies. The visual analogue scale (VAS) emerged as the frequently used pain assessment tool. Diclofenac suppository was compared against other treatments under three categories: placebo, other nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids or opioid-like medicines. The findings revealed that diclofenac suppository was effective in reducing pain compared to placebo and hence, minimized the need for opioids. The concept of combining pain medicines for postoperative management, known as multimodal analgesia, was central to most of the studies. Interpretation: Combination of diclofenac suppositories with other pain relief medicines reduces the need for rescue pain medicines, which are usually opioids such as morphine, meperidine, or pentazocine. Clinical Implications: Patient satisfaction can be improved with these enhanced pain management strategies. Also, reliance on opioids for postoperative pain management and its related side effects will be reduced. This research reinforces the importance of multimodal analgesia in postoperative pain management. The findings also open pathways for further clinical trials to explore the appropriate combinations, dosages, and administration of NSAIDs for specific surgical populations and settings. Future research should focus on standardizing methodologies and addressing risk of bias to enhance reliability of findings related to diclofenac suppository and multimodal analgesia.