A comparative study of a combination of paracetamol infusion (perfalgan) and intramuscular diclofenac versus intravenous pethidine, in the management of post caesarean pain

Abstract

Aim and objective : There is growing increase in the rate of caesarean section delivery. Opioid analgesic use, one of the corner stone options is limited by the development of adverse effects. This study evaluated the efficacy of a multimodal method of pain management with or without opioid analgesic. Patients and Method : Sixty four pregnant women scheduled for elective caesarean section under spinal anesthesia, were randomized to two groups of 32 subjects each. Group PD received 1gm of intravenous paracetamol infusion and 75mg of intramuscular diclofenac while group P received 50mg of IV pethidine at the end of surgery. Both groups also had wound infiltration with 20mls of 0.1% plain bupivacaine (20mg) after skin closure. The proportion of patients who had VAS of d"3 at various time intervals, time to first analgesic request, patient′s satisfaction and side effects/ wound break down were compared. Results : There was no statistical difference between the proportions of patients that were pain free at various time intervals over a period of 24 hours post- operatively, the time to first analgesic request between the groups was not statistically significant. The duration was 242±2.1minutes for the PD group and 181.7±22.1minutes for P group. (P value=0.28). Higher incidences of side effects were observed in the P group with no statistical differences. Patients′ satisfaction was better in the PD group compared to the P group. Conclusion : The study demonstrates that a combination of paracetamol infusion and intramuscular diclofenac has similar analgesic efficacy as intravenous pethidine. This combination can be a good substitute for pethidine.

Keywords

• post caesarean pain
• management
• infusion paracetamol
• diclofenac
• pethidine
• outcome