Comparison of Post-Episiotomy Pain Relief with Diclofenac Suppositories and Oral Indomethacin: A Comparative Study

Abstract

Background & Objective: Perineal pain is a common morbidity following episiotomy, often hindering early maternal mobility, newborn care, and overall recovery. Oral indomethacin has traditionally been used for post-episiotomy pain relief, but gastrointestinal side effects limit its tolerability. Rectal diclofenac suppositories have been suggested as an alternative with potential advantages in efficacy and safety.The objective of this study was to compare the efficacy of rectal diclofenac suppositories with oral indomethacin for relief of post-episiotomy pain in primiparous women.

Methodology: In this comparative study, 70 primigravid women (aged 18–45 years, gestational age ≥37 weeks) undergoing episiotomy at Lahore General Hospital, Lahore, were enrolled through non-probability consecutive sampling. Participants were randomly allocated by balloting to receive either rectal diclofenac suppositories (100 mg every 12 hours) or oral indomethacin (25 mg every 8 hours). Pain intensity was assessed 24 hours postpartum using the Visual Analogue Scale (VAS). Subgroup analyses were performed based on age, body mass index (BMI), and gestational age.

Results: Baseline demographic and clinical characteristics were comparable between groups. Mean VAS pain score at 24 hours was significantly lower in the diclofenac group compared with the indomethacin group (1.86 ± 0.81 vs. 3.26 ± 1.36; p < 0.001). Subgroup analyses confirmed the superiority of diclofenac across all age groups, BMI categories, and gestational age strata. No adverse effects were reported.

Conclusion: Rectal diclofenac suppositories provide superior analgesia compared with oral indomethacin for postepisiotomy pain management, without variation across demographic or clinical subgroups. These findings support the routine use of diclofenac suppositories for post-episiotomy pain relief in obstetric practice.