Diclofenac in the treatment of pain after caesarean delivery: An opioid-saving strategy

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 88; no. 2; pp. 143 - 146
• Main Authors: Olofsson, Christina I., Legeby, Mariann H., Nygårds, Eva-Britt, Östman, Katriina M.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-02-2000; Elsevier
• Subjects: Administration, Rectal; Adult; Analgesia; Analgesics; Analgesics, Opioid - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Cesarean Section; Diclofenac - administration & dosage; Diclofenac - therapeutic use; Double-Blind Method; Female; Humans; Medical sciences; Medicin och hälsovetenskap; Meperidine - administration & dosage; Meperidine - analogs & derivatives; Multimodal postoperative pain relief; Neuropharmacology; Pain relief after Caesarean section; Pain, Postoperative - drug therapy; Pharmacology. Drug treatments; Placebos; Pregnancy; Multimodal postoperative pain relief; Pain relief after Caesarean section; Cesarean section; Human; Drug combination; Treatment efficiency; Narcotic analgesic; Diclofenac; Non steroidal antiinflammatory agent; Arylacetic acid derivatives; Pain; Treatment; Decrease; Surgery; Female; Dose
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/S0301-2115(99)00144-X

Objective: Pain relief of good quality after caesarean section (CS) results in early mobilization and good early mother–child interaction. Patient-controlled analgesia (PCA), with systemic opioids, gives a very high level of patient satisfaction. However, opioids have well documented side-effects i.e. sedation, nausea and respiratory depression. To minimize the risk of such negative effects we studied how far the required dose of opioid could be decreased with a multimodal strategy adding diclofenac.
Study design: In a randomized double-blind study, 50 parturients scheduled for elective CS under spinal anaesthesia, received rectally either diclofenac (Suppositorium diclofenac) 50 mg×3 or placebo 1×3 during the first 24 h postoperatively. All patients had PCA with the possibility of self-administered doses of ketobemidone 1 mg/6 min.
Results: In the group receiving diclofenac rectally the consumption of ketobemidone was reduced with 39% compared to the placebo group.
Conclusion: A multimodal analgetic strategy with the addition of 150 mg diclofenac during the first 24 h after CS reduces the need for opioids significantly with maintained or improved analgetic effect. This is expected to reduce the risk of negative side-effects of systemic opioids.