The impact of diclofenac suppositories on postcesarean section pain: a systematic literature review

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Abstract
Background Managing postoperative pain after cesarean section is imperative, as acute postoperative pain is considered a risk factor for chronic postoperative pain. We investigated the role of diclofenac suppositories in postoperative pain management after cesarean section. Methods For this systematic review, we searched PubMed, Scopus, the Cochrane Library, Google Scholar, and two other clinical trial registers from database inception up to July 23 to July 26, 2024. We included randomized controlled trials and other studies in which diclofenac suppositories were administered as an intentional intervention. We excluded studies not reported in English and without a focus on the principal medicine (diclofenac suppository). Two researchers independently selected studies and evaluated the risk of bias with RoB-2 according to PRISMA-2020 guidelines. Primary outcomes included pain severity or intensity measured with validated clinical scales. We synthesized the studies narratively. Findings: From 203 records, we selected 20 studies. Discrepancies in the study design or its reporting were observed. The visual analogue scale (VAS) was the frequently used pain assessment tool. Diclofenac suppositories were compared under three broad categories: placebo, other nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and opioid-like medicines. The combination of pain medicines (multimodal analgesia) was central to most of the studies; however, heterogeneity and risk of bias undermine the reliability of these findings. Interpretation: Combination of diclofenac suppositories with other NSAIDs reduces the need of rescue pain medicines, which are usually opioids such as morphine, meperidine or pentazocine.

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