Comparison of the effects of indomethacin, diclofenac and acetaminophen suppositories on pain score and pethedine usage after cesarean section

Background : Cesarean section is one of the common surgeries of women. The rate of cesarean section over the west societies is currently about 14%-15%. In Iran the rate of cesarean section is higher than universal statistics. Acute postoperative pain is one of the recognized postoperative complications. It may cause the failure of breast-feeding, if postoperative pain did not control. Also it has effect on psycho emotional relation between newborn and mother. This study was planned to compare the effects of suppositories Indomethacin, Diclofenac sodium and Acetaminophen in opioid usage after cesarean section in Alavi Hospital of Ardabil City. Methods: This study was triple blind clinical trial. 120 candidates of cesarean with spinal anesthesia and ASA I-II were randomly divided in to 4 groups. There were 30 patients in each group. Acetaminophen was used in first group, Indomethacin was used in second group, Diclofenac was used in third group after operation and the dosage was repeated every 6 hours and opioid usage was compared 24 hours after the surgery. Fourth group was selected as control group that was received Placebo suppository and PRN opioid. The severity of pain was recorded on the basis of VAS and if severe pain (VAS >5) was observed, 0.5 mg/kg intramuscular Pethedine had been used. The data were analyzed in SPSS software and analytical statistics such as ANOVA, Chi-square and Post HOC (Tukey HSD). Findings: There was no significant statistical difference between groups in basal data. There was significant statistical difference between control group and other groups in pain score in 1, 12 and 24 hours after operation. There was significant statistical difference between Acetaminophen and NSAIDS (Indomethacin and Diclophenac) in pain score in 12 and 24 hours after operation. The three intervention groups received the first dose of pethidine far more than control group and the distance for both NSAIDs (diclofenac and indomethacin) was a significantly longer. (P<0.001). The use of indomethacin, diclofenac and acetaminophen significantly reduces the amount of pethidine usage in 24 hours after the surgery relation to control group. This reduction in indomethacin and diclofenac groups was more than acetaminophen (P= 0.001). Conclusion: 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 for post cesarean section analgesia