title: Diclofenac in the treatment of pain after caesarean delivery. An opioid-saving strategy.
abstract: OBJECTIVE
  Pain relief of good quality after caesarean section (CS) results in early mobilization and good early mother-child interaction. Patient-controlled analgesia (PCA), with systemic opioids, gives a very high level of patient satisfaction. However, opioids have well documented side-effects i.e. sedation, nausea and respiratory depression. To minimize the risk of such negative effects we studied how far the required dose of opioid could be decreased with a multimodal strategy adding diclofenac.
  
  
  METHODS
  In a randomized double-blind study, 50 parturients scheduled for elective CS under spinal anaesthesia, received rectally either diclofenac (Suppositorium diclofenac) 50 mgx3 or placebo 1x3 during the first 24 h postoperatively. All patients had PCA with the possibility of self-administered doses of ketobemidone 1 mg/6 min.
  
  
  RESULTS
  In the group receiving diclofenac rectally the consumption of ketobemidone was reduced with 39% compared to the placebo group.
  
  
  CONCLUSIONS
  A multimodal analgetic strategy with the addition of 150 mg diclofenac during the first 24 h after CS reduces the need for opioids significantly with maintained or improved analgetic effect. This is expected to reduce the risk of negative side-effects of systemic opioids.
authors.affiliation: Department of Anaesthesia and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
authors.forename: C I
authors.initials: CI
authors.lastname: Olofsson
authors.forename: M H
authors.initials: MH
authors.lastname: Legeby
authors.forename: E B
authors.initials: EB
authors.lastname: Nygårds
authors.forename: K M
authors.initials: KM
authors.lastname: Ostman
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D000698:Analgesia; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002585:Cesarean Section; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008614:Meperidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D010149:Postoperative Pain / Q000188:drug therapy; D010919:Placebos; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010919:Placebos; D004008:Diclofenac; D008614:Meperidine; C012394:ketobemidone