Abstract
Background: Frequent administration of intravenous or intramuscular analgesics is cumbersome in developing countries where skilled nursing staffs are at scarcity. We compared analgesic efficacy between regimen using rectal suppositories only (diclofenac and paracetamol) and regimen using conventional (fixed dose schedule) intramuscular pethidine in patients undergoing cesarean section.Methods: This prospective randomized single blind study included 144 patients undergoing both emergency and elective cesarean section. Suppositories group received diclofenac (50 mg) and paracetamol (1000 mg) suppositories regimen eight hourly for the first 24 hours. Pethidine group received intramuscular pethidine (75mg) eight hourly for the 24 hours. Effectiveness of analgesic regimen was inferred from visual pain score and satisfaction score.Results: Mean visual pain score in two groups was not statistically significant. But higher satisfaction score (Mean ±SD 6.36±1.306 vs 5.83±1.061; p<0.05) and less consumption of rescue analgesic (p < 0.001) was observed in suppositories group than pethidine group. No incidences of abnormal lochia /post-partum hemorrhage or other side effects were found in any study patient.Conclusions: The analgesic regimen using suppositories has not only enhanced patient satisfaction also reduced opioid consumption, thus reduced frequency of intramuscular injection in postoperative ward following cesarean sections.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 56-61
Highlights
With the increase in number of cesarean deliveries (CD), management of post cesarean delivery pain has become a challenge for medical and nursing staff
Three women in group-1 were excluded from the study, because of post dural puncture headache (PDPH) (Figure 1)
There were no significant differences between the two groups in term of age, weight, gravity and parity
Summary
With the increase in number of cesarean deliveries (CD), management of post cesarean delivery pain has become a challenge for medical and nursing staff. High quality analgesia is important to promote early recovery and optimize mother’s ability to care for their newborns.[1,2] Most of our hospitals are using fixed dose schedule of intramuscular opioid. Around the world in many institutions patient controlled analgesia (PCA) and neuraxial opioid have replaced traditional intramuscular opioid injection. In developing country with scarcity of skilled nursing stuff, along with fiscal crisis; PCA and neuraxial opioid are not convenient option. Repeated intramuscular injection may be uncomfortable for many women. Frequent administration of intravenous or intramuscular analgesics is cumbersome in developing countries where skilled nursing staffs are at scarcity. We compared analgesic efficacy between regimen using rectal suppositories only (diclofenac and paracetamol) and regimen using conventional (fixed dose schedule) intramuscular pethidine in patients undergoing cesarean section
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