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Murdoch I, Carver AL, Sultan P, O’Carroll JE, Blake L, Carvalho B, Onwochei DN, Desai N. Comparison of different nonsteroidal anti-inflammatory drugs for cesarean section: a systematic review and network meta-analysis. Korean J Anesthesiol 2023; 76:597-616. [PMID: 37066603 PMCID: PMC10718621 DOI: 10.4097/kja.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/22/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Cesarean section is associated with moderate to severe pain and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed. The optimal NSAID, however, has not been elucidated. In this network meta-analysis and systematic review, we compared the influence of control and individual NSAIDs on the indices of analgesia, side effects, and quality of recovery. METHODS CDSR, CINAHL, CRCT, Embase, LILACS, PubMed, and Web of Science were searched for randomized controlled trials comparing a specific NSAID to either control or another NSAID in elective or emergency cesarean section under general or neuraxial anesthesia. Network plots and league tables were constructed, and the quality of evidence was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis. RESULTS We included 47 trials. Cumulative intravenous morphine equivalent consumption at 24 h, the primary outcome, was examined in 1,228 patients and 18 trials, and control was found to be inferior to diclofenac, indomethacin, ketorolac, and tenoxicam (very low quality evidence owing to serious limitations, imprecision, and publication bias). Indomethacin was superior to celecoxib for pain score at rest at 8-12 h and celecoxib + parecoxib, diclofenac, and ketorolac for pain score on movement at 48 h. In regard to the need for and time to rescue analgesia COX-2 inhibitors such as celecoxib were inferior to other NSAIDs. CONCLUSIONS Our review suggests the presence of minimal differences among the NSAIDs studied. Nonselective NSAIDs may be more effective than selective NSAIDs, and some NSAIDs such as indomethacin might be preferable to other NSAIDs.
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Affiliation(s)
- Iona Murdoch
- Department of Anesthesia, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Anthony L Carver
- Department of Anesthesia, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - James E O’Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lindsay Blake
- University of Arkansas for Medical Sciences Library, Little Rock, AR, USA
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Desire N. Onwochei
- Department of Anesthesia, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, London, United Kingdom
| | - Neel Desai
- Department of Anesthesia, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College London, London, United Kingdom
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Hadid S, Tomsis Y, Perez E, Sharabi L, Shaked M, Haze S. The role of expectations, subjective experience, and pain in the recovery from an elective and emergency caesarean section: A structural equation model. J Reprod Infant Psychol 2023:1-19. [PMID: 36879419 DOI: 10.1080/02646838.2023.2187357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Rapid return to mobilisation and daily function is essential for recovery after an elective and emergency caesarean section, prevention of short- and long-term complications, and mothers' well-being. High pain levels may delay recovery. Considering the biopsychosocial model, recovery is additionally complex and comprises social and psychological aspects. OBJECTIVE This study examined the relationships between preoperative expectations, perioperative subjective experience, postoperative pain levels, and postoperative interruption of functioning and recovery. METHODS Overall, 306 women completed a set of questionnaires on the fourth day after a caesarean section regarding their demographic information, levels of expectation matching the caesarean section and the perioperative subjective experience, and the pain levels and interruption to daily activities 24 hours postpartum. RESULTS Using a structural equation model, a gap between preoperative expectations and perioperative experience related to a poorer perioperative subjective experience was found. This was associated with higher postoperative pain levels that were directly and indirectly related to the interruption of various functions and activities during the initial 24 hours postpartum. The model explained 58% of the variance in postpartum functioning and had good goodness-of-fit (χ2 = 242.74, df = 112, χ2/df = 2.17, NFI = 0.93, CFI = 0.96, TLI = 0.94, RMSEA = 0.06). Additionally, pain levels were higher and daily activities were more severely impaired for women who had undergone emergency caesarean section compared to those who had undergone elective caesarean section. CONCLUSION The need for preoperative preparation and setting expectations, perioperative emotional support, continuous communication with the mother, and an efficient postoperative pain management was highlighted.
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Affiliation(s)
- Salam Hadid
- Nursing school, Zefat academic college, Zefat, Israel
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Yeela Tomsis
- Nursing school, Zefat academic college, Zefat, Israel
| | - Ester Perez
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Limor Sharabi
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Moshit Shaked
- Maternity ward, Galilee medical center, Nahariya, Israel
| | - Shani Haze
- Maternity ward, Galilee medical center, Nahariya, Israel
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Ofor IJ, Enebe JT, Ofor NE, Onyia CN, Omeke CA, Nevo CO, Enyinna PC, Awkadigwe FI, Eleje GU, Ezugwu FO. Pentazocine with rectal diclofenac versus pentazocine alone for pain relief following caesarean delivery in Enugu, Nigeria: A randomized controlled trial. J Int Med Res 2022; 50:3000605221102092. [PMID: 35638533 PMCID: PMC9160910 DOI: 10.1177/03000605221102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To measure postoperative pain relief following the use of rectal diclofenac combined with intramuscular pentazocine compared with intramuscular pentazocine alone in patients undergoing a caesarean delivery. Methods This single-blind randomized controlled trial enrolled pregnant women that had a caesarean section at the Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria. Study participants were randomized to receive either 100 mg of rectal diclofenac given every 12 h plus 30 mg of intramuscular pentazocine given every 6 h (group A) or 60 mg of intramuscular pentazocine given every 6 h (group B). The primary outcome was the level of pain as measured using a visual analogue scale. The secondary outcomes were the level of satisfaction with pain relief and need for rescue analgesia. Results A total of 200 participants were randomized equally into the two groups. Participants in group A had significantly better pain control and satisfaction over the 48 h after surgery compared with group B. Significantly more of group B required rescue analgesia for breakthrough pain compared with group A. Conclusion Rectal diclofenac combined with intramuscular pentazocine was significantly better at controlling pain compared with pentazocine alone in the first 48 h following caesarean section. Trial registration number: PACTR202107706925314 at www.pactr.org on 28 July 2021.
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Affiliation(s)
- Ifeanyichukwu Jude Ofor
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology - Teaching Hospital, Parklane, Enugu, Nigeria
| | - Joseph Tochukwu Enebe
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology - Teaching Hospital, Parklane, Enugu, Nigeria.,Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology, College of Medicine, Government Residential Area, Parklane, Enugu, Nigeria
| | - Nwadiuto Emmanuela Ofor
- Departments of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria
| | - Christian Nnaemeka Onyia
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology, College of Medicine, Government Residential Area, Parklane, Enugu, Nigeria
| | - Chidimma Akudo Omeke
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology - Teaching Hospital, Parklane, Enugu, Nigeria
| | - Calistus Obiora Nevo
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology - Teaching Hospital, Parklane, Enugu, Nigeria
| | - Perpetua Cleopatra Enyinna
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology - Teaching Hospital, Parklane, Enugu, Nigeria
| | - Fredrick Ikenna Awkadigwe
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology - Teaching Hospital, Parklane, Enugu, Nigeria
| | - George Uchenna Eleje
- Effective Care Research Unit, Departments of Obstetrics and Gynaecology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Nigeria
| | - Frank Okechukwu Ezugwu
- Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology, College of Medicine, Government Residential Area, Parklane, Enugu, Nigeria
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Garba JA, Panti AA, Nnadi DC, Ango IG, Tunau KA, Bello S, Zubairu S, Nasir AM, Ibrahim R. The efficacy of pentazocine + diclofenac versus paracetamol + diclofenac for post- caesarean section analgesia. Niger Postgrad Med J 2021; 28:187-192. [PMID: 34708705 DOI: 10.4103/npmj.npmj_404_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The most common major obstetric procedure is caesarean section (CS) and one of the greatest concerns for women after CS is to have optimal pain relief. Aim This study aims to compare the efficacy of pentazocine + diclofenac and paracetamol + diclofenac on post-operative analgesia after CS. Methodology This was a single-blind, randomised trial. Pregnant women that had CS were randomized into two groups. Group A received intramuscular pentazocine + rectal diclofenac postoperatively. Group B received intramuscular paracetamol + rectal diclofenac postoperatively. Post-operative pain was assessed by numeric rating scale at 1 h after the surgery, at 6 h, 12 h and 24 h. The result obtained was analysed using SPSS Version 22 and P < 0.05 was considered statistically significant. Results The median pain scores in both groups ranged from 2 to 3 across all periods of assessment. The pain relief was slightly better in the pentazocine + diclofenac group with no significant difference in the pain score between the two groups at all periods of assessment. The satisfaction level was good in 66.3% and 69.5% of the participants in the pentazocine + diclofenac and paracetamol + diclofenac group respectively but the difference was not statistically significant (χ2 = 4.14, P = 0. 12). Nausea, vomiting and drowsiness were significantly more in the pentazocine + diclofenac combination (P < 0.001). Conclusion Both combination of analgesics provided adequate analgesia but pentazocine + diclofenac combination had better pain relief but was more associated with side effects.
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Affiliation(s)
- Jamila Abubakar Garba
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Abubakar Abubakar Panti
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Daniel C Nnadi
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ibrahim G Ango
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Karima A Tunau
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Saratu Bello
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Saad Zubairu
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Asmau'u Muhammad Nasir
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Rukayya Ibrahim
- Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Egede JO, Ajah LO, Umeora OU, Ozumba BC, Onoh RC, Obuna JA, Ekem N. Pentazocine Alone Versus Pentazocine Plus Diclofenac for Pain Relief in the First 24 Hours after Caesarean Section: A Randomized Controlled Study. J Clin Diagn Res 2017; 11:QC01-QC05. [PMID: 28571211 DOI: 10.7860/jcdr/2017/25294.9519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Postoperative pain is one of the main postoperative adverse outcomes following caesarean section. Its management still remains a challenge especially in a low resource setting. AIM To compare the efficacy of intramuscular pentazocine alone and combined intramuscular pentazocine with diclofenac for pain relief within 24 hours after caesarean section. MATERIALS AND METHODS This was a double blind randomized control study of post caesarean section pain management of 140 participants between April and December, 2015 at the Federal Teaching hospital, Abakaliki. Inclusion criteria involved consenting and low risk parturients who had caesarean section under spinal anaesthesia. The participants were randomly grouped into Pentazocine-Placebo (PP) group and Pentazocine-Diclofenac (PD) group. The PP group received pentazocine 30 mg every 4 hours for 24 hours and 3 milliliters of water for injection as placebo 12 hourly for 24 hours while the PD group received pentazocine 30 mg every 4 hours and diclofenac 75 mg every 12 hours for 24 hours. The level of pain control was assessed using the Visual Analog Scale (VAS). The data was analysed with IBM SPSS version 20.0. The level of significance was set at < 0.05. RESULTS The use of PD for 24 hour post caesarean section analgesia achieved better pain relief, faster onset of postoperative ambulation, bowel sound auscultation and oral feeding than the use of PP (p-value ≤0.002). However, the use of PD is more expensive than PP (p-value =0.0001). There was no difference between the two groups of participants on the passage of flatus and duration of hospital stay (p-value≥0.05). The use of PP was associated with more maternal side effects (p-value=0.009). There was no difference on the level of satisfaction between the two groups of participants (p-value≥0.05). CONCLUSION The use of PD for post caesarean section analgesia is more effective in achieving a satisfactory pain relief and has less side effects.
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Affiliation(s)
- John Okafor Egede
- Senior Registrar, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Leonard Ogbonna Ajah
- Senior Lecturer, Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Odidika Ugochukwu Umeora
- Professor, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Benjamin Chukwuma Ozumba
- Professor, Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Robinson Chukwudi Onoh
- Lecturer, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Johnson Akuma Obuna
- Senior Lecturer, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Napoleon Ekem
- Senior Registrar, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
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