DOI: https://doi.org/10.36347/sjams.2024.v12i11.038

Pages: 1670-1676

Background: Post-cesarean pain management remains challenging, balancing effective analgesia with minimizing adverse effects on maternal-newborn bonding and breastfeeding. This study compared the efficacy of combined non-opioid rectal suppositories versus traditional intramuscular pethidine for post-cesarean pain management. Methods: In this prospective, randomized, single-blind study, 100 patients undergoing cesarean section were allocated into two groups of 50 each. The suppositories group received diclofenac (50 mg) and paracetamol (1000 mg) suppositories every eight hours, while the pethidine group received intramuscular pethidine (75 mg) every eight hours for 24 hours. Primary outcomes included visual analog scale (VAS) pain scores and patient satisfaction. Secondary outcomes included time to first ambulation, rescue analgesic requirements, adverse effects, and breastfeeding success. Results: The suppositories group demonstrated comparable or lower pain scores, particularly after 8 hours (24-hour VAS at rest: 2.4 ± 0.9 vs 3.2 ± 1.1, p=0.001). Time to first ambulation was significantly shorter in the suppositories group (12.4 ± 2.8 vs 15.6 ± 3.2 hours, p=0.001). The suppositories group showed significantly lower incidence of adverse effects including nausea (16% vs 44%, p=0.002), vomiting (8% vs 30%, p=0.005), and sedation (4% vs 36%, p=0.001). Breastfeeding success rates were higher in the suppositories group (92% vs 76%, p=0.028), with higher patient satisfaction scores (median 4 vs 3, p=0.001). Conclusion: The combination of diclofenac and paracetamol suppositories provides effective post-cesarean analgesia with significant advantages over intramuscular pethidine, including fewer adverse effects, earlier mobilization, and improved breastfeeding success. This non-opioid regimen represents a viable first-line option for post-cesarean pain management.