A randomized controlled trial of rectal diclofenac sodium and intramuscular pentazocine versus intramuscular pentazocine, diclofenac, and paracetamol analgesics for pain relief in the first 48 h after cesarean section

Background: Cesarean section is one of the most commonly performed operations in obstetric practice. A multimodal approach to post-cesarean pain management has been shown to be more effective than a unimodal approach, though the most effective combination and preferred route of administration are still unknown. Aim: To compare the effectiveness of rectal diclofenac sodium and intramuscular pentazocine versus intramuscular pentazocine, paracetamol, and diclofenac analgesics for pain relief in the first 48 h after cesarean section at Federal Medical Centre, Katsina. Methods: This was a prospective single-blind, randomized controlled trial, in which 120 booked women planned for cesarean section were recruited and randomly allocated to the study or control group. The study group received 100 mg rectal diclofenac sodium 12 h and intramuscular pentazocine 60 mg 6 h, while the control group received intramuscular diclofenac 75 mg 12 h, pentazocine 60 mg 6 h, and paracetamol 600 mg 8 h for the first 48 h postoperatively. Pain perception, maternal satisfaction, and preferred route of drug administration were compared between the two groups. Results: The study group had significantly lower mean visual analog scale pain scores and higher maternal satisfaction in the first 48 h (P < 0.05). There were no significant differences in the maternal and newborn side effects of the analgesics. The rectal route of drug administration was more preferred (P < 0.05). Conclusion: The study showed that rectal diclofenac sodium and intramuscular pentazocine post-cesarean section analgesic efficacy and maternal satisfaction were superior to that of intramuscular pentazocine, diclofenac, and paracetamol.