Effectiveness of Rectal Versus Oral Diclofenac for Perineal Pain Relief following Episiotomy Repair at a Tertiary Hospital in Port Harcourt, Nigeria: A randomized controlled study
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Keywords
Episiotomy repair, Perineal pain, Diclofenac, Rectal route, Oral intake, Maternal satisfaction, Mean pain score, Visual analogue scale
Abstract
Background: Perineal pain following episiotomy repair is a common complaint after vaginal delivery and may be severe, requiring the use of strong analgesics. Diclofenac is a non-steroidal anti-inflammatory drug commonly used for pain relief. This study aimed to compare the effectiveness of rectal versus oral Diclofenac in the management of pain post-episiotomy repair.
Methodology: A prospective double-blind randomized controlled study was carried out involving 132 booked mothers who had episiotomy repair after vaginal delivery at a tertiary hospital in Port Harcourt, Nigeria. They were randomized into two groups and received either rectal diclofenac 100mg and oral placebo 12 hourly (Group A), or oral diclofenac 100mg and rectal placebo 12 hourly (Group B), for 48 hours following the repair. Perineal pain was measured using Visual Analogue Scale (VAS). Both groups were monitored for 48 hours (pain relief assessed at 6, 12, 18, 24, 36 and 48) and the analgesic effectiveness compared. The data obtained was analysed using IBM SPSS version 24. The recruitment spanned from 1st September 2023 to 30th January 2024.
Results: Both groups were similar in their baseline socio-demographic characteristics. The overall mean pain score was significantly lower in the rectal diclofenac group than the oral diclofenac group (4.14±0.42 vs. 4.30±0.44, t=2.01, p=0.048). Majority of the participants in the rectal route expressed more satisfaction (66.7% vs. 37.1%, χ2=23.08, p<0.01). The mean time interval (hours) between drug administration and the first urine void was similar in both groups (3.19±3.13 vs. 3.29±3.11, t=0.29, p=0.74), and there was no difference in the requirement for additional analgesia (12.1% vs. 9.1%, χ2=0.32, p=0.57).
Conclusion: Diclofenac suppository was more effective in management of perineal pain following episiotomy repair and the participants in the rectal route group expressed more satisfaction than their counterparts who received the oral drug.
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