Comparison of Suppository Diclofenac and Oral Acetaminophen Codeine in Pain Relief after Episiotomy

Document Type : Original Article


1 Associate Professor of Obstetrics & Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Medical Student, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Post partum perineal pain is one of the disturbing problems in women who have recently given birth. It causes limitation in movement, urination, defecation and also restricts taking care of infant and breast feeding. The purpose of this study was to compare the efficacy of two analgesics; suppository Diclofenac sodium and acetaminophen codeine tablet in the management of post episiotomy perineal pain, while sitting, walking and passing urine.
Methods: In this interventional study which was performed on women who had vaginal delivery and episiotomy in Imam Reza Hospital in Mashhad in year 2008 a total number of 70 women were randomly assigned to receive either suppository Diclofenac (100 mg every 12 hr) or acetaminophen codeine tablet (320 mg every 6 hr) up to 12 hours after episiotomy. The inclusion criteria were vaginal birth with episiotomy. Pain ratings were recorded before the administration of the drugs and 3 hours after last dose by visual-analog scale. Effect of the two drugs on perineal pain relief was compared. Data was analyzed by using of SPSS11.5 and Chi square and Mann-Whitney tests.
Results: Suppository Diclofenac sodium is significantly more effective than acetaminophen codeine in pain relief while sitting, walking and urination after episiotomy (p<0.001).
Conclusion: Using rectal Diclofenac sodium is a simple, effective method of reducing pain after episiotomy.


1. Albers LL, Borders  N. Minimizing genital tract trauma  and related  pain  following spontaneous vaginal
birth. J Midwifery Womens Health 2007 May­Jun;52(3):246­53.
2. Hedayati H, Parsons J, Crowther CA. Rectal analgesia for pain from perineal trauma following childbirth . Cochrane Database Syst Rev. 2003;(3):CD003931.
3. Dodd JM, Hedayati H, Pearce E, Hotham N, Crowther CA. Rectal analgesia for the relief of perineal pain  after childbirth: a randomised controlled trial of diclofenac suppositories. BJOG 2004 Oct;111(10):1059­64.
4. Facchinetti F, Casini ML, Costabile L, Malavasi B, Unfer V. Diclofenac pyrrolidine versus Ketoprofen for
the relief of pain  from episiotomy: a  randomized  controlled  trial. Acta  Obstet Gynecol Scand  2005 
Oct;84(10): 951­5.
5. Lim SS, Tan PC, Sockalingam JK, Omar SZ. Oral celecoxib versus oral diclofenac for post­perineal repair analgesia after spontaneous vaginal birth: a randomized trial. Aust N Z J Obstet Gynaecol 2008 Feb;
6. Kamondetdecha R, Tannirandorn Y .Ibuprofen versus acetaminophen for the relief of perineal pain after childbirth: a randomized controlled trial. J Med Assoc Thai 2008 Mar; 91(3):282­6.
7. Peter EA, Janssen PA, Grange  CS, Douglas MJ. Ibuprofen  versus  acetaminophen  with codeine for the 
relief of perineal pain after childbirth: a randomized controlled trial. CMAJ 2001 Oct 30;165(9):1203­9.
8. Searles JA, Pring DW. Effective analgesia following perineal injury during childbirth: a placebo controlled 
trial of prophylactic rectal diclofenac. Br J Obstet Gynaecol. 1998 Jun;105(6):627­31.
9. Yildizhan R, Yildizhan B, Sahin S, Suer N. Comparison of the efficacy of diclofenac and indomethacin  suppositories in treating perineal pain after episiotomy or laceration: a  prospective, randomized, double­ blind clinical trial. Arch Gynecol Obstet. 2009 Nov;280(5):735­8.