Conquering Post-Episiotomy Pain: A GRADE-Qualified Meta-Analysis of Diclofenac Rectal Suppositories Compared with Other NSAIDs

Articles in Press

Document Type : Systematic Review

Authors

Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

10.22038/jmrh.2024.80159.2400

Abstract

Introduction: Pain management following episiotomy is a critical aspect of postpartum care. This study aims to provide a rigorous synthesis of the available evidence regarding the efficacy of diclofenac rectal suppositories compared to other NSAIDs in the management of post-episiotomy pain.
Methods: We conducted a comprehensive literature search in main databases from their inception to 22 May 2024. RCTs comparing the effectiveness of diclofenac rectal suppositories with placebo or other NSAIDs in managing post-episiotomy pain in women with a mediolateral episiotomy were included. The quality of included RCTs was assessed using the Cochrane Risk of Bias tool (RoB2). All analyses were performed using the RevMan version 5.4. To determine the quality of evidence, we used the GRADE tool.
Results: Eleven articles were included in the systematic review and nine RCTs including 1577 women were included in the meta-analysis. The findings showed that in the diclofenac group, the post-episiotomy pain at 24 hours after delivery was significantly lower than the placebo (SMD=-1.49, 95% CI -2.45 to -0.53, p=0.002) and oral diclofenac group (MD=-1.64, 95% CI -2.80 to -0.49, p=0.005). the findings also showed that although the use of diclofenac rectal suppositories had reduced perineal pain compared to the rectal indomethacin, this was not significant (MD=-0.89, 95% CI -2.28 to 0.50, p=0.21). The quality of evidence was very low to moderate.
Conclusion: This study provides valuable insights into the use of diclofenac rectal suppositories for post-episiotomy pain management. However, further high-quality, RCTs are needed to confirm these findings.

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Journal of Midwifery and Reproductive Health

Articles in Press, Accepted Manuscript
Available Online from 15 October 2025

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