Comparison of the effects of diclofenac suppository and tramadol injection and the combination of these two drugs on pain after spinal anesthesia for cesarean

Document Type : Original Article


1 Associate professor, Department of Obstetrics and Gynecology, Women's Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate professor, Department of Anesthesia, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Pharmacist, Mashhad, Iran.

4 Expert in Medicine Library, Mashhad, Iran.


Introduction: Caesarean section is one the most common gynecologic procedures. Pain after cesarean has adverse effects on different organs of the body. To reduce pain after cesarean, different methods are used. This study was performed aimed to compare the effects of diclofenac suppositories with intravenous tramadol on pain after cesarean section.
Methods: This double-blind clinical trial was conducted in 2007 on 66 women who were volunteers for cesarean section with spinal anesthesia. They were randomly assigned to one of the treatment groups of 100 mg tramadol injection, receiving 100 mg diclofenac suppository and receiving a combination of two drugs. After caesarean section, the patients were checked in terms of pain severity each one hour and with the onset of pain as grade 2, they were placed in one of the studied groups and then again the pain was evaluated each one hour. Demographic data and results of the study were collected in the questionnaire. The data were analyzed using the SPSS statistical software (version 16) and student t-test, Mann-Whitney and Wilcoxon tests, ANOVA and chi-square test. PResults: The mean duration of analgesia from the time of lenitive injection was 134.7 min in tramadol group, 386.3 min in diclofenac group and 453.2 min in combination of these two drugs that this time was significantly lower in tramadol group than diclofenac and combination of two drugs (P<0.015, P<0.000). The duration of analgesia in the group of combination of tramadol and diclofenac was 66.8 min more than diclofenac suppository alone that was not statistically significant (P<0.746).
Conclusion: With regard to the acceptable duration of analgesia after cesarean section, it is recommended that diclofenac suppository which is a non-invasive, inexpensive, easy and without opioids complications be used instead of tramadol injection.


  1. Stoelting RK, Miller RD Basics of anesthesia. 4th ed. New York: Churchil Livingstone; 2005.P. 230-45.
  2. Soler Company E, Faus soler M, Montaner, Morales OF, Martine Z, Ponsnavarro V. Factors affecting postoperative pain. Rev Esp Anestesiol Reanim 2001 Apr 48: 48(4), 163-70.
  3. Clive H, Wilder – smith MD, et al. post operative sensitition and pain after cesarean delivery and effects of single IM doses of tramadol and diclofenac alone and in combination. Anesth analg. 2003: 97: 526-33.
  4. Dennis AR, Leeson – Payne CG, Hobbs GJ. Analgesia after caesarean section. The use of rectal diclofenac as an adjunct to spinal morphine. Anesthesia. 1995 Apr: 50(4): 297-9.
  5. Olofsson IO, Legeby MH, Nygard EB, Osrman KM. diclofenac in the treatment of pain cesarean delivery. Eur J obstet Gynecol 1998: 40(11): 130-35.
  6. Way WL, Way EL, Fields HL. Opioid analgesics. In : Katzung BG. Basic and clinical pharmacology. 6th ed. New York: Mc Graw Hill, 2002.P. 460-77.
  7. Payan DG, Katzung BG. Nonsteroidal anti inflammatory drugs. In: Katzung BG. Basic and clinical pharmacology. 6th ed. New York: Mc Graw Hill, 2002.P.460-77.
  8. Bogras J, Arara N, Srivast P. synergistic effect of interathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section, BMC anesthesiol. 2005 May 17.5(1): 5
  9. Bano F, Sabbar S, Zafar N, et al. intrathecal fentanyl as adjnct to hyperbaric bupivacaine in spinal anesthesia for caesarean section. J coll physicians surg Pak. 2006 Feb: 16(2): 87-90.