title: The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioids consumption after cesarean section.
abstract: BACKGROUND
  Cesarean section is one of the common surgeries of women. Acute post-operative pain is one of the recognized post-operative complications.
  
  
  OBJECTIVE
  This study was planned to compare the effects of suppositories, indomethacin, diclofenac and acetaminophen, on post-operative pain and opioid usage after cesarean section.
  
  
  METHODS
  In this double-blind clinical trial study, 120 candidates of cesarean with spinal anesthesia and American Society of Anesthesiologists (ASA) I-II were randomly divided into four groups. Acetaminophen, indomethacin, diclofenac, and placebo suppositories were used in groups, respectively, after operation and the dosage was repeated every 6 h and pain score and opioid usage were compared 24 h after the surgery. The severity of pain was recorded on the basis of Visual Analog Scale (VAS) and if severe pain (VAS > 5) was observed, 0.5 mg/kg intramuscular pethidine had been used.
  
  
  METHODS
  The data were analyzed in SPSS software version 15 and analytical statistics such as ANOVA, Chi-square, and Tukey's honestly significant difference (HSD) post-hoc.
  
  
  RESULTS
  Pain score was significantly higher in control group than other groups, and also pain score in acetaminophen group was higher than indomethacin and diclofenac. The three intervention groups received the first dose of pethidine far more than control group and the distance for diclofenac and indomethacin were significantly longer (P < 0.001). The use of indomethacin, diclofenac, and acetaminophen significantly reduces the amount of pethidine usage in 24 h after the surgery relation to control group.
  
  
  CONCLUSIONS
  Considering the significant decreasing pain score and opioid usage especially in indomethacin and diclofenac groups rather than control group, it is suggested using of indomethacin and diclofenac suppositories for post-cesarean section analgesia.
authors.affiliation: Ardabil University of Medical Sciences, Iran.
authors.forename: Godrat
authors.initials: G
authors.lastname: Akhavanakbari
authors.forename: Masood
authors.initials: M
authors.lastname: Entezariasl
authors.forename: Khatereh
authors.initials: K
authors.lastname: Isazadehfar
authors.forename: Fariba
authors.initials: F
authors.lastname: Kahnamoyiagdam
keywords: Acetaminophen; cesarean section; diclofenac; indomethacin; opioid