title: Comparison between Preoperative Rectal Diclofenac Plus Paracetamol and Diclofenac Alone for PostoperativePain of Hysterectomy.
abstract: OBJECTIVE
  To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy.
  
  
  METHODS
  Ninety female patients (American Society of Anesthesiologists (ASA) physical status I-II), scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS ) was used to assess pain intensity at rest.
  
  
  RESULTS
  In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg) compared to diclofenac group (16.8± 2.8 mg) and placebo group (20.1 ± 3.6 mg) (p<0.05). VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p<0.05). There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p<0.05).
  
  
  CONCLUSIONS
  According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone.
authors: Department of anesthesiology, women Hospital, Tehran University of medical sciences, Tehran, Iran.
authors: Saghar
authors: S
authors: Samimi Sede
authors: Department of obstetrics & gynecology, women Hospital, Tehran University of medical sciences, Tehran, Iran.
authors: Fateme
authors: F
authors: Davari Tanha
authors: Department of obstetrics & gynecology, women Hospital, Tehran University of medical sciences, Tehran, Iran.
authors: Mehrnaz
authors: M
authors: Valadan
authors: Department of anesthesiology, women Hospital, Tehran University of medical sciences, Tehran, Iran.
authors: Zeinab
authors: Z
authors: Modaressi
keywords: Paracetamol; Postoperative Pain; Rectal Diclofenac
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