Comparative Effects of Single Agent Rectal Diclofenac versus a Combination of Rectal Diclofenac and Intramuscular Pentazocine, on Post Caesarean Section Pain Relief in a Tertiary Institution in Southern Nigeria

Background: Caesarean section commonly causes moderate to severe pain in the first 24 hours after surgery with associated discomfort, delayed ambulation, difficulty initiating breastfeeding and prolonged hospital stay. Receiving adequate analgesia after caesarean section is very important for the patient’s comfort, overall wellbeing and recovery.

Objective: To compare the efficacy, time to rescue-analgesia and side effects of single agent rectal diclofenac versus its combination with intramuscular pentazocine for pain management after caesarean section in Rivers State University Teaching Hospital (RSUTH).

Methodology: A randomized double-blind clinical trial was carried out at the RSUTH. A total of 120 patients scheduled for either elective or emergency caesarean section were recruited. Group ‘A’ received rectal diclofenac 100 mg and intramuscular placebo (unimodal group) while group ‘B’ received rectal diclofenac 100mg and intramuscular pentazocine 30 mg (multimodal group). Socio-demographic information was collected via structured proforma, while Visual Analog Scale (VAS) was used to assess the level of pain. Data were analyzed using SPSS version 20 and statistical significance was set at p < 0.05.

Results: The mean ages of respondents in unimodal and multimodal groups were 31.7 ± 4.3 years and 31.3 ± 5.2 years respectively. The difference in the median pain score and range was significant only at 8 hours between the groups, there was no significant difference before and after 8 hours. Although the mean time (in minutes) to first rescue-analgesia was shorter in the unimodal (147.5 ± 60.1) as compared to the multimodal group (170.0), this difference was not statistically significant. There was no side effect noticed in either of the two groups.

Conclusion: The combined agents (diclofenac and pentazocine) had a superior analgesic effect to the single agent (diclofenac alone) when given as used in the study.