• C I Olofsson, M H Legeby, E B Nygårds, and K M Ostman.
• Department of Anaesthesia and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
• Eur. J. Obstet. Gynecol. Reprod. Biol. 2000 Feb 1;88(2):143-6.

ObjectivePain relief of good quality after caesarean section (CS) results in early mobilization and good early mother-child interaction. Patient-controlled analgesia (PCA), with systemic opioids, gives a very high level of patient satisfaction. However, opioids have well documented side-effects i.e. sedation, nausea and respiratory depression. To minimize the risk of such negative effects we studied how far the required dose of opioid could be decreased with a multimodal strategy adding diclofenac.Study DesignIn a randomized double-blind study, 50 parturients scheduled for elective CS under spinal anaesthesia, received rectally either diclofenac (Suppositorium diclofenac) 50 mgx3 or placebo 1x3 during the first 24 h postoperatively. All patients had PCA with the possibility of self-administered doses of ketobemidone 1 mg/6 min.ResultsIn the group receiving diclofenac rectally the consumption of ketobemidone was reduced with 39% compared to the placebo group.ConclusionA multimodal analgetic strategy with the addition of 150 mg diclofenac during the first 24 h after CS reduces the need for opioids significantly with maintained or improved analgetic effect. This is expected to reduce the risk of negative side-effects of systemic opioids.

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