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Original ArticleOpen Access
Intramuscular Diclofenac for Analgesia after Cesarean Delivery: A Randomized Controlled Trial
Surakarn J 
,
Tannirandorn Y
,
Tannirandorn Y Objective: To evaluate the effectiveness of intramuscular diclofenac in postoperative cesarean section pain
control.
Study design: A randomized controlled trial.
Setting: Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital.
Subjects: Eighty patients scheduled for elective cesarean section between October 2007 and April 2008.
Material and Method: All patients had cesarean section performed under spinal anesthesia with spinal
morphine and randomized into two groups by a table of randomization. They were to receive diclofenac 75 mg
intramuscular every 12 hours for 2 doses or standard rescue drugs (Tramadol).
Outcome measurements: The number of patients who required rescue drugs, pain score (VAS), side effects of
diclofenac, and satisfaction were evaluated for 48 hours postoperatively.
Results: In the diclofenac group, no patient required rescue drug compared to 20% of patients in the control
group (p < 0.05). Median pain scores were less in the diclofenac group at 6 hours ( 1 (range 0-6) vs. 4 (range
0-6), p = 0.002), 12 hours ( 2 (range 0-5) vs. 3 (range 0-7), p = 0.031), and 24 hours (1.5 (range 0-4) vs. 3
(range 1-8), p < 0.0001), respectively. No side effects of diclofenac (e.g. gastrointestinal bleeding, bleeding
tendency, uterine atony, or injection site irritation) were observed. Satisfaction was comparable in both
groups.
Conclusion: Diclofenac can be used safely to reduce the requirement of rescue drugs for pain control in
postoperative cesarean section.
Keywords: Cesarean section, Diclofenac, Injections, Intramuscular, Pain, Postoperative, Tramadol, Pain
measurement
control.
Study design: A randomized controlled trial.
Setting: Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital.
Subjects: Eighty patients scheduled for elective cesarean section between October 2007 and April 2008.
Material and Method: All patients had cesarean section performed under spinal anesthesia with spinal
morphine and randomized into two groups by a table of randomization. They were to receive diclofenac 75 mg
intramuscular every 12 hours for 2 doses or standard rescue drugs (Tramadol).
Outcome measurements: The number of patients who required rescue drugs, pain score (VAS), side effects of
diclofenac, and satisfaction were evaluated for 48 hours postoperatively.
Results: In the diclofenac group, no patient required rescue drug compared to 20% of patients in the control
group (p < 0.05). Median pain scores were less in the diclofenac group at 6 hours ( 1 (range 0-6) vs. 4 (range
0-6), p = 0.002), 12 hours ( 2 (range 0-5) vs. 3 (range 0-7), p = 0.031), and 24 hours (1.5 (range 0-4) vs. 3
(range 1-8), p < 0.0001), respectively. No side effects of diclofenac (e.g. gastrointestinal bleeding, bleeding
tendency, uterine atony, or injection site irritation) were observed. Satisfaction was comparable in both
groups.
Conclusion: Diclofenac can be used safely to reduce the requirement of rescue drugs for pain control in
postoperative cesarean section.
Keywords: Cesarean section, Diclofenac, Injections, Intramuscular, Pain, Postoperative, Tramadol, Pain
measurement
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