Journal of Midwifery and Reproductive Health

Journal of Midwifery and Reproductive Health

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

Document Type : Systematic Review

Authors
Maryam Shami 1
Mahnaz Azari 1
Solmaz Mohammadi 1
Marzieh Nikkholgh 2
Somayeh Makvandi 1
1 PhD, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Lecturer, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
10.22038/jmrh.2024.80159.2400
Abstract
Background & aim: Pain management following episiotomy—a surgical cut made in the perineum during childbirth—is a vital component of postpartum care. This study aimed to rigorously synthesize available evidence regarding the efficacy of diclofenac rectal suppository compared to the placebo or other NSAIDs in managing post-episiotomy pain.
Methods: This review followed the PRISMA 2020 guidelines. Randomized controlled trials comparing diclofenac rectal suppository with placebo or other NSAIDs in women with mediolateral episiotomy were identified through a comprehensive database search up to August 14, 2025. Risk of bias was assessed using the Cochrane RoB 2 tool. Meta-analyses were conducted using RevMan 5.4, and the quality of evidence was evaluated with GRADE.
Results: Eleven articles were included in the systematic review, with nine RCTs involving 1577 women included in the meta-analysis. Overall risk of bias ranged from low to high Overall, diclofenac rectal suppository consistently reduced pain compared with both placebo and other NSAIDs, with effect sizes varying by comparator. Diclofenac rectal suppository significantly reduced post-episiotomy pain at 24 hours compared with placebo (SMD = −1.49, 95% CI −2.45 to −0.53; p = 0.002) and oral diclofenac (MD = −1.64, 95% CI −2.80 to −0.49; p = 0.005). No significant difference was observed compared with rectal indomethacin (MD = −0.89, 95% CI −2.28 to 0.50; p = 0.21). The quality of evidence ranged from very low to moderate.
Conclusion: This study provides insights into using diclofenac rectal suppository for post-episiotomy pain management. However, further high-quality RCTs are needed to confirm these findings.
Keywords
Diclofenac
NSAIDs
Rectal Suppository
Episiotomy
Pain
Subjects
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Journal of Midwifery and Reproductive Health
Volume 14, Issue 1
Winter 2026
Pages 5136-5151