Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories.
OBJECTIVE
To evaluate rectal diclofenac in the relief of perineal pain after trauma during childbirth.


METHODS
A randomised, double-blind trial.


METHODS
Delivery Suite, Women's and Children's Hospital, South Australia.


METHODS
Women with a second-degree (or greater) perineal tear or episiotomy.


METHODS
Women were randomly allocated to either diclofenac or placebo suppositories (Anusol), using a computer-generated randomisation schedule with stratification for parity and mode of birth. Treatment packs contained two x 100 mg diclofenac or two placebo suppositories, the first being inserted when suturing was complete, and the second 12-24 hours after birth. Women were asked to complete questionnaires at 24 and 48 hours after birth relating to their degree of perineal pain using the validated Short Form McGill Pain Questionnaire.


METHODS
Pain scores at 24 and 48 hours after birth.


RESULTS
A total of 133 women were recruited, with 67 randomised to diclofenac suppositories and 66 to placebo. Women in the diclofenac group were significantly less likely to experience pain at 24 hours while walking (RR 0.8; 95% CI 0.6 to 1.0), sitting (RR 0.8; 95% CI 0.6 to 1.0), passing urine (RR 0.6; 95% CI 0.4 to 1.0) and on opening their bowels (RR 0.6; 95% CI 0.2 to 0.9) compared with those women who received placebo. These differences were not sustained 48 hours after birth.


CONCLUSIONS
The use of rectal non-steroidal anti-inflammatory drug suppositories is a simple, effective and safe method of reducing the pain experienced by women following perineal trauma within the first 24 hours after childbirth.
Dodd
Jodie M
JM
Maternal and Perinatal Clinical Trials Unit, Department of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Hedayati
Hedyeh
H
Pearce
Elizabeth
E
Hotham
Neil
N
Crowther
Caroline A
CA
D000285:Administration, Rectal; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010146:Pain / Q000517:prevention & control*; D010502:Perineum; D011247:Pregnancy; D011644:Puerperal Disorders / Q000517:prevention & control*; D013488:Suppositories
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac