title: Relieving perineal pain after perineorrhaphy by diclofenac rectal suppositories: a randomized double-blinded placebo controlled trial.
abstract: BACKGROUND
  Perineal pain after episiotomy is a common problem following vaginal birth. The pain affects either physical or mental function negatively. There are many methods in perineal pain relief such as local ice pack and a bath, ultrasound, oral anesthesia, and intravenous anesthesia. Analgesic rectal suppository is one of various methods in pain relief especially in drowsy patients, or when oral preparation causes gastric discomfort, nausea or vomiting.
  
  
  OBJECTIVE
  To assess the effectiveness of diclofenac rectal suppositories for relief perineal pain after perineorrhaphy.
  
  
  METHODS
  A randomized double-blinded placebo controlled trial.
  
  
  METHODS
  Seventy-two term, singleton, pregnant women who gave vaginal birth with second to third degree episiotomy tears were randomized with envelop concealment to either diclofenac or placebo rectal suppositories group. Each group received two tablets of 50 mg diclofenac or two tablets of look-alike placebo rectal suppositories. Visual analogue scale was used for scaling pain score before administration of the medications, and at 30 minutes, 1, 2, 12, and 24 hours after administration.
  
  
  RESULTS
  No differences were found in the median pain scores before administration of medications and at 30 min, 1 hour and 2 hour after administration (p > 0.05), while the median pain scores were significantly reduced in the diclofenac group at 12 and 24 hours after administration compared to the control group (4.5 vs. 0.0; p < 0.001 and 2.0 vs. 0.0; p = 0.02 for 12 hours and 24 hours, consecutively).
  
  
  CONCLUSIONS
  The present study suggested that diclofenac suppository was effective on reducing perineal pain after episiotomy, especially at 12 and 24 hours after administration.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Vuthinun
authors.initials: V
authors.lastname: Achariyapota
authors.forename: Vitaya
authors.initials: V
authors.lastname: Titapant
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use*; D004311:Double-Blind Method; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010502:Perineum / Q000473:pathology*; D011247:Pregnancy; D012007:Rectum / Q000187:drug effects*; D013488:Suppositories
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac