Comparison of Morphine Suppository and Diclofenac Suppository for Pain Management After Elective Caesarean Section
This study investigated efficacy and side effects of Morphine suppository for pain management after the first elective caesarean delivery in comparison to Diclofenac suppository. One hundred women aged 18-40 with term pregnancies undergoing elective caesarean section for the first time participated in this prospective project. Exclusion criteria included drug sensitivity, fetal malformations or defects, and complications during the cesarean operation. After same spinal anesthesia and same surgical techniques and in the recovery room patients consecutively received 100 mg diclofenac suppository or 10 mg morphine suppository. The pain severity was rated by “Numerical Rating Scale.” There was not the difference between two groups in terms of basal information. Pain score was significantly different between two groups in the first 12 hours (5.66 ±1.36 in morphine group and 3.63±0.96 in diclofenac group) but not in the second 12 hour period. Considering pain scores every two hours in first 12 hours and every 4 hours in second 12 hours, morphine group had higher scores in comparison to diclofenac group. Also, the morphine group required pethidine injection sooner than the other group. The time giving first pethidine injection was 3.28±2.16 hours after operation in morphine group and 5.24±4.07 hours after operation (P<0.05). This study demonstrated that diclofenac suppository in comparison to morphine suppository decreased subjective pain scores in the first twenty-four hours after elective caesarean section which reached statistical significance in the first twelve hours. Although in diclofenac group, pethidine injection was prescribed significantly later.
Chestnut DH. 4th ed. Chestnut's obstetric anesthesia principles and practice. Philadelphia: Mosby, 2009.
Thienthong S, Chongsomchai C, Kemthong W.A placebo-controlled, double-blind, randomized study of single-dose intravenous diclofenac for pain relief after a cesarean section. Acta Anaesthesiol Taiwan. 2012 ;50(4):150-2.
Bozkurt N, Kurdoglu M, Kurdoglu Z, Kutlusoy F, Biberoglu K.
Postoperative pain control after cesarean section: can diclofenac sodium be used instead of meperidine? J Matern Fetal Neonatal Med 2009;22(12):1144-50.
Surakarn J, Tannirandorn Y. Intramuscular diclofenac for analgesia after cesarean delivery: a randomized controlled trial. J Med Assoc Thai 2009;92(6):733-7.
Akhavanakbari G, Entezariasl M, Isazadehfar K, Kahnamoyiagdam F.
The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioids consumption after cesarean section. Perspect Clin Res 2013;4(2):136-41.
Lavand'homme PM, Roelants F, Waterloos H, De Kock MF. Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective cesarean delivery. Anesthesiology 2007;106(6):1220-5.
Bush DJ, Lyons G, MacDonald R. Diclofenac for analgesia after caesarean section. Anaesthesia 1992 ;47(12):1075-7.
Mitra S, Khandelwal P, Sehgal A. Diclofenac-tramadol vs. diclofenac-acetaminophen combinations for pain relief after caesarean section. Acta Anaesthesiol Scand 2012;56(6):706-11.
Munishankar B, Fettes P, Moore C, McLeod GA. A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. Int J Obstet Anesth 2008;17(1):9-14.
Rashid M, Jaruidi HM. The use of rectal diclofenac for post-cesarean analgesia. Saudi Med J 2000;21(2):145-9.
Lim NL, Lo WK, Chong JL, Pan AX. Single dose diclofenac suppository reduces post-Cesarean PCEA requirements. Can J Anaesth 2001;48(4):383-6.
Olofsson CI, Legeby MH, Nygårds EB, Ostman KM. Diclofenac in the treatment of pain after caesarean delivery. An opioid-saving strategy. Eur J Obstet Gynecol Reprod Biol 2000;88(2):143-6.
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