A randomized controlled trial of rectal analgesia with diclofenac sodium for relief of perineal pain following child birth

Abstract

To evaluate rectal diclofenac sodium in the relief of perineal pain after trauma during childbirth a randomized, double blind trial was conducted. Women with an episiotomy or lesser or equal perineal tears to second degree including vestibular tears, which required suturing at the Obstetric Department (Ward 21), Professorial Unit, Colombo South Teaching Hospital, Kalubowila were enrolled. Women were randomly allocated to either diclofenac sodium or placebo suppositories (Anusol) , using a random - number table. Treatment packs contained two, diclofenac sodium 100 mg and diclofenac sodium 50 mg suppositories or two placebo suppositories, The first (diclofenac sodium 1 OOmg or placebo) was inserted when suturing was completed , and the second (50mg diclofenac sod- -ium or placebo) 12 hours after birth. Women were asked to indicate their degree of perineal pain with different activities (resting/ walking/ sitting and squatting) 24 hours after birth , using visual analogue scale. Main outcome measure was overall pain score at 24 hours after birth. A total of 169 women were recruited, with 84 randomized to diclofenac sodium suppositories and 85 to placebo. Women in the diclofenac sodium group were significantly less likely to experience pain within 24 hours of delivery (percentage of mean pain score reduction, 45%, P < .001) with different activities compared placebo. The use of rectal diclofenac sodium is a simple and effective method of reducing the pain experienced by women following perineal trauma within the first 24hours after childbirth. This study was done in Colombo South Teaching Hospital as a partial requirement for MD in Obstetrics & Gynaecology in March 2008. Results were included in a thesis with one published paper in Sri Lanka Journal o f Obstetricians and Gynaecologists. Abstract presentation was done in annual scientific session o f Sri Lanka College of Obstetricians & Gynaecologists.