Background & Aims

According to IASP- Pain is defined as an unpleasant, subjective sensory and emotional experience associated with potential tissue damage or described in terms of such damage. It is an unavoidable component of the post surgical experience and even the most fortunate of patients is not exempted.
Adequate pain relief in the post-caesarean period remains an essential component of the care of pregnant women. Unfortunately, this is not the case in many developing countries from many studies.
The aim is to assess the safety and efficacy of rectal diclofenac and paracetamol for pain control after caesarean section in the first 24 hours after caesarean section by:
1) comparing patients with severe pain at 0, 2, 6,10,18 and 24 hours after Caesarean del.
2) number in each arm requiring additional analgesia for breakthrough pain
3) diffferences in post-operative complications such as pyrexia, haemorrhage, nausea etc
4) compare overall patient satisfaction between the two treatment arms

Methods

This was a prospective double-blinded randomised controlled study.
The setting was Kuje Hospital – a 250 bed district general hospital serving an estimated 500,000 population in Nigeria.
One hundred and twenty post-caesarean section patient were studied. Sixty patients were in each arm of the study. Group A received 50mg of rectal diclofenac at 8 hourly interval for 24 hours. Group B received 300mg rectal paracetamol at 8 hourly interval for 24 hours. Both groups had intramuscular pentazocine 0.5mg/kg at 6 hourly interval as adjuvant analgesia. Breakthrough pain defined as pain score on the visual analogue scale(VAS) greater than six was given intramuscular 0.5mg/kg pentazocine
Data collation using questionnaires and the VAPS)chart and analysed using SPSS and MedCalc statistical packages.
Eligible parturients who consented were randomly allocated to either group A or B using a random allocation sequence from the random number table.
Blinding was achieved using opaque envelopes

Results

Mean age of subjects was 29years. 35%(42)were primigravidae, while 65%(78) were multiparae.
58%(70) patients had emergency caesarean section(CS) while 42% had elective CS.
The mean analogue pain score ( VAPS) for severe pain (VAPS 7 and above) at 24 hours after C/S was 2.3 AND 2.8 for Group A and B respectively. Both had a median score of 2 and modal score of 1.
Difference in pain score at 24 hours was not statistically significant(P:0.0924; RR: 0.1667; 95%CI: 0.0207-1.3429). Five patients in group A had a total of 210mg IM pentazocine for breakthrough pain and eight had 270mg in group B(P:0.3841; RR: 0.6250; 95% CI: 0.2169 – 1.8013) a total of 480mg. The difference between the groups was not statistically significant.
Overall patient satisfaction was above 80% for both arms.
Incidence of post-op pyrexia(38.0C) and above was 18.3% and 16.5% in groups A and B respectively.
Difference in complications was not significant(P:0.7183;RR:1.0769; 95%CI: 0.7247 – 1.6003)

Conclusions

Both rectal diclofenac and paracetamol are effective and safe options for use as analgesia after caesarean delivery with adjuvant intramuscular pentazocine to help boost their efficacy.
Patient satisfaction following their use is high and results obtained from this study confirms that either of the two protocols is safe for use in setting.
As cost is a major consideration in access to quality care in developing countries, these approaches especially the combination of rectal acetaminophen(paracetamol) and pentazocine will be attractive to our clients looking for affordable but effective options for pain relief. These patients often pay for medical services using very limited resources which are required for other competing demands such as feeding, accommodation and education for their children.

References

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Presenting Author

Tejas Sankar

Poster Authors

Ahmed Abdullahi

MBBS, Dip. Anaesthesia, MRCOG,

National Hospital Abuja Nigeria

Lead Author

Tejas Sankar

MD

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Obstetric and Labor Pain