Relieving Perineal Pain after Perineorrhaphy by Diclofenac Rectal Suppositories: A Randomized Double-Blinded Placebo Controlled Trial

Background: Perineal pain after episiotomy is a common problem following vaginal birth. The pain affects either physical or mental function negatively. There are many methods in perineal pain relief, such as local ice pack and a bath, ultrasound, oral anesthesia, and intravenous anesthesia. Analgesic rectal suppository is one of various methods in pain relief, especially in drowsy patients, or when oral preparation causes gastric discomfort, nausea or vomiting. Objective: To assess the effectiveness of diclofenac rectal suppositories for relief perineal pain after perineorrhaphy. Design: A randomized double-blinded placebo controlled trial. Material and Method: Seventy-two term, singleton, pregnant women who gave vaginal birth with second to third degree episiotomy tears were randomized with envelop concealment to either diclofenac or placebo rectal suppositories group. Each group received two tablets of 50 mg diclofenac or two tablets of look-alike placebo rectal suppositories. Visual analogue scale was used for scaling pain score before administration of the medications, and at 30 minutes, 1, 2, 12, and 24 hours after administration. Results: No differences were found in the median pain scores before administration of medications and at 30 min, 1 hour, and 2 hour after administration (p > 0.05), while the median pain scores were significantly reduced in the diclofenac group at 12 and 24 hours after administration compared to the control group (4.5 vs. 0.0; p < 0.001 and 2.0 vs. 0.0; p = 0.02 for 12 hours and 24 hours, consecutively). Conclusion: The present study suggested that diclofenac suppository was effective on reducing perineal pain after episiotomy, especially at 12 and 24 hours after administration.