Background and aim:Principles of a multimodal strategy include control of postoperative pain to allow early mobilization, early enteral nutrition and attenuation of the perioperative stress response through the use of regional anesthetic techniques and a combination of analgesic agents. This study aimed to evaluate the impact of diclofenac, hydrocortisone and a combination of both on prevalence and postoperative pain on women underwent elective cesarean section.
Materials and Methods: This double-blind clinical trial was performed on 150 pregnant females who were candidates for cesarean section surgery. The patients were randomly divided into three groups of 50 subjects. Group I received 100 mg sodium diclofenac suppository and 2cc intravenous normal saline, Group II received 100 mg intravenous hydrocortisone and a placebo suppository and Group III received a combination of hydrocortisone and diclofenac suppository. Mean arterial blood pressure and heart rate in each group were monitored and compared 10 minutes before the spinal anesthesia (prior to catheterization of the bladder) at the end of surgery and one hour after recovery. Postoperative pain was assessed with numerical pain scale for up to 24 hours after surgery in all three groups and tranquilizer was administered if needed as well as the first time to request analgesics and total analgesic dosage levels in each of the groups were recorded and compared. If pain severity has reached an elevated level (Severity Level 4), the dose of diclofenac suppository administrated is recorded in the file. If the pain becomes worse and more constant, Pethidine Ampoule (25 mg) is administered intravenous (suppository is repeated in less than 8 hours if necessary). Data analysis was performed using SPSS software.
Findings: There was no significant difference between the three groups in terms of age and gestational age. Changes in mean arterial pressure in the in the third group (combination) were less than the other two groups. Patients in the hydrocortisone group received a higher dose of analgesics and a combination therapy group received a lower dose of HER (P <0.05).
Conclusion:According to the results, administration of diclofenac suppository with intravenous hydrocortisone in reducing pain after cesarean section is more effective than any of the medications alone.