This study evaluated the efficacy and safety of repeated intramuscular injections of 75 mg of diclofenac sodium for controlling postoperative pain in 120 women after cesarean section under general anesthesia, compared to placebo. Results showed diclofenac significantly reduced pain scores within the first hour and 45 patients required only diclofenac for pain relief over 48 hours compared to all placebo patients requiring additional opioid. Diclofenac also reduced sedation scores over 6-12 hours without increasing uterine relaxation or bleeding compared to placebo. The study concludes repeated diclofenac injections can effectively relieve post-cesarean pain while reducing opioid needs with no safety issues over 48 hours.

1. Efficacy and safety of repeated postoperative administration of intramuscular diclofenac sodium in
the treatment of post-cesarean section pain: a double-blind study.
Al-Waili NS - Arch. Med. Res. - ; 32(2); 148-54
Abstract
Analgesic drugs, either opioids or non-opioids, are required and useful for controlling postoperative
pain after cesarean section. The analgesic and opioid-sparing effects of repeated intramuscular (i.m.)
injections of 75 mg of diclofenac sodium given immediately after the experiencing of pain following
cesarean section under general anesthesia were studied and compared with placebo in a double-
blind trial. One hundred twenty patients 18-40 years of age undergoing elective lower segment
cesarean section were treated with either 75 mg diclofenac sodium i.m. (60 patients) or identical
placebo (60 patients), once patients awakened from anesthesia and experienced wound pain. Their
initial responses to either treatment during the first hour after administration of medications were
studied. The analgesic, sedative, and opioid-sparing effects of the medications were also studied
during the next 48 h. Side effects including uterine relaxation and bleeding were compared between
patients administered placebo and diclofenac. Results showed that 55/60 patients showed
significant pain relief within the first 1 h after administration of diclofenac sodium and their mean
pain score decreased from 7.09 +/- 1.06 to 0.85 +/- 0.8 (p <0.05). Within the same period, 10/60
patients responded to placebo injections and mean pain score decreased from 6.6 +/- 0.96 to 0.8 +/-
0.78 (p <0.05). During the first postoperative 48 h, 45 patients showed complete pain relief with use
of diclofenac alone while 15 patients required 2,800 mg of pethidine in addition to diclofenac
treatment. All patients using placebo required pethidine injection; the total amount of pethidine
used was 22,700 mg per 48 h. Verbal scores for sedation were lower in patients treated with
diclofenac than in patients treated with placebo at 6 and 12 h postoperatively (p <0.05). There were
no significant differences in the proportions of patients who required oxytocin infusion due to
uterine relaxation in the diclofenac-treated and the placebo-treated groups (7/60 vs. 12/60, p
>0.05). It might be concluded that repeated i.m. injections of 75 mg diclofenac sodium (maximum
two injections per day) could relieve postoperative pain after cesarean section and significantly
reduce opioid analgesic requirements without significant effects on uterine relaxation or bleeding
during the first postoperative 48 h.
Citation
Efficacy and safety of repeated postoperative administration of intramuscular diclofenac sodium in
the treatment of post-cesarean section pain: a double-blind study.
Al-Waili NS - Arch. Med. Res. - ; 32(2); 148-54
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