Rectal Diclofenac Versus Oral Diclofenac in the Management of Pain after Episiotomy Repair: A Randomised Controlled Trial at LAUTECH (now UNIOSUN) Teaching Hospital, Osogbo, Osun State, Nigeria

Background Safe and effective analgesia following episiotomy repair reduces postpartum morbidity. Oral diclofenac has proven to be of benefit in pain control, however, there is a need for an alternative route with the same analgesic efficacy because of the common significant side effects on the gastrointestinal tract. Hence, this study compared the effectiveness of rectal diclofenac to oral diclofenac in the management of pain after episiotomy repair at LAUTECH Teaching Hospital, Osogbo. Methods A randomised trial was carried out among parturients that had vaginal delivery and episiotomy repair from May to October 2020. 82 parturients (41 in each arm) were randomised to either 50mg oral or 50mg rectal diclofenac 12hourly for 24 hours after episiotomy repair. Pain score and level of maternal satisfaction were assessed, degree of side effects was also measured. Chi-square and Student t-test were used to identify association. Results There was no significant difference between the randomised groups in any socio-demographic characteristics. Rectal diclofenac group had a lower pain score (Rectal, Mean + SD 3.15+1.35 versus Oral, 6.46 + 2.85 p-value <0.0001), less need for additional analgesia (36.6% oral versus 7.3% of rectal, p-value =0.001) and improved level of maternal satisfaction compared to oral route (68.3% in rectal versus 2.4% in oral). Conclusions Irrespective of any socio-demographic characteristics, rectal diclofenac is more effective, has a high degree of acceptability and maternal satisfaction than oral diclofenac following episiotomy repair.