Abstract

A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL OF DICLOFENAC OR DEXAMETHASONE IN THE COMBINATION OF TRAMADOL FOR PAIN RELIEF AFTER CAESAREAN SECTION

Kaveh Behaeen*, Sholeh Nesioonpour, Reza Akhondzadeh, Shaghayegh Mousavian

Abstract

Background: Pain relief after caesarean section (CS) leads to early ambulation and good early mother–child bounding. Best to our knowledge there is no published study assessing the combination of opioid +NSAID vs. opioid +steroid (anti-inflammatory) drugs to diminish post-caesarean section pain. In the present study we assessed the pain-relieving quality of combination tramadol with diclofenac vs. dexamethasone on post-caesarean section pain management. Method: Eighty eligible pregnant female who were candidate for elective C/S were randomly assigned to two groups to receive tramadol 100mg IV with diclofenac 75mg IM group (TDF) vs. tramadol 100mg IV with dexamethasone 8mg IV group (TDX) post-operatively. All patients underwent spinal anesthesia. Pain severity was quantified according to visual analogue scale (VAS), ranging 0: no pain to 10: worst pain that could not tolerate, and recorded on[2, 4, 8, 12], and 24 hours post C/S operation. Each patient given extra analgesic pethidine (0.2mg/kg) if needed (VAS 3 or more). The first time that patients complaint from pain and request analgesic drug and total amount of pethidine was recorded. Results: The first time that patients complained from pain were105 15min in (TDF) group and90 20min in (TDX) groups (p<0.05). The mean of the time that patients request extra analgesic drug pethidine were 130 10min in (TDF) group and 110 12min in (TDX) group (p<0.05). The mean of total VAS score at 4h and 8h after surgery were significantly lower in (TDF) group (p=0.04). Conclusion: It was shown that combination of tramadol with diclofenac can significantly diminish post caesarean section pain and reduce the usage of pethidine post operatively.

Keywords: caesarean section, pain, diclofenac, dexamethasone, tramadol, satisfaction.