Diclofenac and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine

Background and Objectives: A multimodal approach to postcesarean pain manag ement may enhance analgesia and reduce side effects after surgery. This stu dy evaluates the postoperative analgesic effects of propacetamol and/or dic lofenac in parturients undergoing elective cesarean delivery under spinal a nesthesia. Methods: After randomization, 80 healthy parturients received the following : placebo (group M), 100 mor diclofenac rectally every 8 hours (group AID), 2 g propacetamol intravenously every 6 hours (group MP), or a combination of 2 g propacetamol and 100 mg diclofenac (group MDP) as described above. D rugs were administered for 24 hours after surgery. Postoperative pain was c ontrolled with a patient controlled analgesia pump, using morphine. The vis ual analog scale (VAS) at rest and on coughing, as well as the morphine con sumption, were evaluated at 2, 6, and 24 hours postoperatively. Also, the s ide effects experienced after undergoing the different regimens were compar ed. Results: The patients' characteristics did not differ significantly between the 4 groups. VAS score at 2 hours, both at rest and on coughing were lowe r in group MDP and MD compared with group M (P < .05). At 24 hours, there w as still a tendency toward lower pain scores in the groups MDP and MD; howe ver, this difference was only statistically significant at rest between the MDP group and the MP and M groups. Morphine consumption at 2, 6, and 24 ho urs was lower in the MDP and MD groups compared with the MP and M groups (P < .05). The morphine-sparing effect was higher in groups MDP and MD compar ed with group MP (57% and 46%, respectively, v 8.2%, P < .05). The incidenc e of side effects was similar in all groups. However, the power of the stud y was too low to permit an evaluation of potential side effects. Conclusion: Diclofenac after cesarean delivery improves analgesia and has a highly significant morphine-sparing effect. We were unable to demonstrate significant morphine-sparing effect of propacetamol or additive effect of p ropacetamol and diclofenac in this group of patients.