Comparison of rectal suppository and injectable diclofenac in post operative pain control following inguinal herniorrhaphy in mulago hospital.

Abstract

BACKGROUND: Fundamental to a rapid post-operative recovery and good quality care of a surgical patient in adequate pain control. Injectable diclofenac is used in the control of mederate and severe post operative pain, but this route of drug administration is costly becuase not only does it require a lot of personnel but also syringes, needles and antiseptics. The rectal suppository seems a feasible option but there are no studies in uganda that have compared the rectal and intramuscular routes to disclofenac administration. STUDY OBJECTIVE: To determine whether diclofenac suppository is as effective as intramuscular diclofenac in post operative pain control following inguinal herniorrhaphy STUDY DESIGN: A prospective randomized clinical trial was carried out on patients undergoing elective inguinal herniorrhaphy. Patients were grouped into groups, A and B. Group A received intramuscular diclofenac 8 hourly and group B recieved disclofenac rectal suppository 12 hourly. Pain intensity scores were recorded every 12 hours for 48 hours. RESULTS: Between September 2001- February 2002 a total of 80 patients were recruited into the study. Three patients in group B withdrew their consent in the middle of the study. Of 77 patients whose results were analyzed a total of seven patients (9% of total) required a rescue analgesic and of these 71.4% belonged to group A. The pain intensity scores at 12.24.36 and 48 hours for patients in group B were lower than the scores for patients in group A and this was significantly significant. CONCLUSIONS: The rectal route of diclofenac as a suppository is more effective than the intramuscular route The acceptability of the suppository is not universal considering the 7.5% of patients who dropped out in group B because they did not want this route of drug administration.