Comparison of the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoperative cesarean section pain; a randomized clinical trial
School of Medicine Students' Journal,
Vol. 2 No. 3 (2020),
1 July 2020
Background and aims: Postoperative pain after cesarean section is one of the important issues in gynecology. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are two of the drugs that are used for cesarean pain management. Considering the adverse effects of opioids in the mother and the baby, NSAIDs are preferred in the post-cesarean pain management. This study was designed to compare the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoperative cesarean pain.
Materials and Methods: This randomized clinical trial was conducted on patients who underwent cesarean section in Taleghani Hospital during 2019. Patients were randomly divided into two groups based on flipping coin. The first group received 100 mg of oral diclofenac potassium every 6 hours and the second group received 100 mg of diclofenac sodium suppository every 6 hours. The pain was assessed 30 minutes, 2 hours, 6 hours, 12 hours, 18 hours and 24 hours after the intervention using visual analogue scale (VAS) before and after analgesics.
Results: Eighty-four patients were included in the final analysis. The mean of VAS during the intervention in the diclofenac sodium suppository group and in the Cataflam group was 3.42 ± 2.1 and 1.93 ± 2.4 respectively (P value = 0.011). Twenty-eight among 46 patients who received opioids due to severe pain (66.7%) were in the diclofenac suppository group and 18 of them (42.9%) were in the Cataflam group (P value = 0.021).
Conclusion: Diclofenac potassium tablets and diclofenac sodium suppository can reduce the post cesarean pain. The efficacy of diclofenac potassium tablets (Cataflam) is significantly higher than the diclofenac suppository; however, the complication rate was not significantly different.
How to Cite
Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. The Lancet. 2019;393(10180):1537-46.
Correll D. Chronic postoperative pain: recent findings in understanding and management. F1000Research. 2017;6.
Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-98.
Duan G, Yang G, Peng J, Duan Z, Li J, Tang X, et al. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC anesthesiology. 2019;19(1):189.
Leung AY. Postoperative pain management in obstetric anesthesia–new challenges and solutions. Journal of clinical anesthesia. 2004;16(1):57-65.
Chi X, Li M, Mei W, Liao M. Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post–cesarean section pain management and lactation after general anesthesia–a prospective, randomized, double-blind, controlled study. Journal of pain research. 2017;10:1521.
Loane H, Preston R, Douglas M, Massey S, Papsdorf M, Tyler J. A randomized controlled trial comparing intrathecal morphine with transversus abdominis plane block for post-cesarean delivery analgesia. International journal of obstetric anesthesia. 2012;21(2):112-8.
Aluri S, Wrench I. Enhanced recovery from obstetric surgery: a UK survey of practice. International journal of obstetric anesthesia. 2014;23(2):157-60.
Kakade A, Wagh G. Evaluate the Feasibility of Surgical Transversus Abdominis Plane Block for Postoperative Analgesia After Cesarean Section. The Journal of Obstetrics and Gynecology of India. 2019;69(4):330-3.
Fiore Jr JF, Olleik G, El-Kefraoui C, Verdolin B, Kouyoumdjian A, Alldrit A, et al. Preventing opioid prescription after major surgery: a scoping review of the literature on opioidfree analgesia. British Journal of Anaesthesia. 2019.
Akhavanakbari G, Entezariasl M, Isazadehfar K, Kahnamoyiagdam F. The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioids consumption after cesarean section. Perspectives in clinical research. 2013;4(2):136.
Raja SR, Gowda T, Kumar T, Mehta D, Arya K. Analgesic efficacy and safety of transdermal and oral diclofenac in postoperative pain management following dental implant placement. General dentistry. 2017;65(4):69-74.
Naz S, Memon NY, Sattar A, Baloch R. Diclofenac rectal suppository: an effective modality for perineal pain. J Pak Med Assoc. 2016;66(8):1005-8.
Mahdavi A, Telkabadi Z, Aleyasin A, Hosseini MA, Safdarian L, Momenzadeh A. Comparison of morphine suppository and diclofenac suppository for pain management after elective caesarean section. Acta Medica Iranica. 2016:709-12.
Butwick A. Improving post‐caesarean analgesia: where to next? BJOG: An International Journal of Obstetrics & Gynaecology. 2017;124(7):1071-.
Dilger K, Herrlinger C, Peters J, Seyberth HW, Schweer H, Klotz U. Effects of celecoxib and diclofenac on blood pressure, renal function, and vasoactive prostanoids in young and elderly subjects. The Journal of Clinical Pharmacology. 2002;42(9):985-94.
Hinz B, Dormann H, Brune K. More pronounced inhibition of cyclooxygenase 2, increase in blood pressure, and reduction of heart rate by treatment with diclofenac compared with celecoxib and rofecoxib. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2006;54(1):282-91.
Bavry AA, Thomas F, Allison M, Johnson KC, Howard BV, Hlatky M, et al. Nonsteroidal anti-inflammatory drugs and cardiovascular outcomes in women: results from the women’s health initiative. Circulation: Cardiovascular Quality and Outcomes. 2014;7(4):603-10.
Ibrahim KS, El‐Yazbi AF, El‐Gowelli HM, El‐Mas MM. Opposite Modulatory Effects of Selective and Non‐Selective Cyclooxygenase Inhibition on Cardiovascular and Autonomic Consequences of Cyclosporine in Female Rats. Basic & clinical pharmacology & toxicology. 2017;120(6):571-81.
George N, Gurk-Turner C, Etcheson J, Gwam C, De RS, Smith S, et al. The Addition of Diclofenac to a Multimodal Pain Control Regimen Decreases Postoperative Pain and Opioid Consumption. Surgical technology international. 2017;31:346-51.
- Abstract Viewed: 347 times
- PDF Downloaded: 70 times