Abstract

Background: Gynecological laparoscopic surgeries are being widely accepted over open procedures due to its various advantages including, patient satisfaction, cosmetic benefit, quick recovery and less pain. Despite comparatively less postoperative pain as oppose to open surgeries, further minimizing pain is still achievable.

Aim: To compare the effectiveness of using pre-emptive versus postoperative per rectal diclofenac sodium to minimize postoperative pain.

Methods: A Randomized control trial was conducted among 122 patients presented to Colombo South Teaching Hospital for gynecological laparoscopic surgeries. Interventional group received diclofenac sodium suppository preoperatively. Control group received a placebo preoperatively and Diclofenac sodium suppository postoperatively. Sequentially numbered opaque closed envelops were used to achieve allocation concealment. Postoperative pain was assessed by visual analogue pain scale in pre-determined time intervals after the surgery.

Results: Mean value of the time taken for the surgeries were 98.52 minutes (SD=4.98). Significantly low mean pain scores were observed from the study participants at 2-hour, 6 hour and 24-hour intervals with a p value of <.001. This significance persisted even when the study population was analysed according to length and extent of the surgery categorized as Major, Minor and Diagnostic procedures with p values of <0.05, <0.001 and <0.001 respectively. Furthermore, significantly less amount of additional analgesics was needed for participants who received diclofenac sodium pre-operatively.

Conclusions: When diclofenac sodium suppositories were administered pre-operatively for pain relief, need of additional analgesics during the post-operative period was significantly less. Post-surgical pain score of the participants who were given pre-operative Diclofenac Sodium suppositories were significantly less than the pain score of the participants who were given post-operative Diclofenac Sodium suppositories.