301. Effect of non-steroidal anti-inflammatory drugs (NSAIDs) on post-operative analgesia after ceaserean section: Randomised controlled trial

Abstract

Introduction NSAIDs can cause an elevation in BP but are administered regularly post operatively after caesarean section. The effectiveness of NSAID in this setting was assessed. Objective Assess the effectiveness of oral NSAIDs on patient perceived pain compared to placebo in healthy women following caesarean section. Methods A multicentre, prospective, stratified randomization (with minimisation), double blind parallel placebo controlled trial was undertaken in 4 Australian metropolitan hospitals. Commencing immediately post operatively after the caesarean section, women received either diclofenac orally, 50 mg three times a day with food or placebo for a maximum of 5 days. All women received paracetamol 1 g four times a day and had access to a variety of opioid analgesia. The amount of opioid analgesia was converted to morphine to allow for comparisons. A visual analog scale (VAS) assessing the ’usual’ amount of pain and the ’worst’ pain each day of admission was completed by each participant. Results Of 284 women randomised, the results of 270 women were analysed- 136 women in the placebo and 134 in the NSAID group. Women were well matched at baseline. There was no difference in the simple analgesia administered to the NSAID and placebo group (p > 0.05). There was a reduction in pain over time in both groups; however women in the placebo group had higher VAS scores compared to the NSAID group for all days expect Day 5 post-partum (eg Day 1: Placebo 52.6 (95%CI 48.9–56.5) vs NSAID 46.0 (95%CI 42.1–49.9); p = 0.008). The placebo group also required greater amounts of narcotic based analgesics. Discussion NSAIDs resulted in less patient assessed pain and a reduction in the amount of narcotics administered post caesarean in women with uncomplicated pregnancies.