COMPARISON OF RECTAL DICLOFENAC SODIUM VERSUS INTRAMUSCULAR TRAMADOL FOR PAIN RELIEF IN MANUAL VACUUM ASPIRATION

Abstract

Manual Vacuum Aspiration using paracervical block is commonly employed for management of first trimester miscarriage. Opioids like tramadol and non-steroidal anti-inflammatory drugs like diclofenac are employed in addition to paracervical block for analgesia. This study was conducted to compare efficacy of rectal diclofenac sodium versus intramuscular tramadol for pain relief in Manual Vacuum Aspiration. Method: This randomized controlled trial was conducted at Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad from 21 January to 20 July 2017. A sample size of 114 was calculated, 57 in each group. In Group A, patients received injection tramadol 100 mg intramuscularly 20 minutes before Manual Vacuum Aspiration. In Group B patients received diclofenac suppository 100 mg rectally 60 minutes before procedure. Within three minutes of completion of procedure patients were asked to rate their pain scores on Visual Analogue Scale. Results: Both groups were comparable in terms of age, parity and gestational age. The mean pain score of Group A (intramuscular tramadol) was 5.05±0.72 whereas that for Group B (diclofenac suppository) was 2.88±0.85 (p<0.001). Frequency of patients for group A in mild, moderate and sever pain categories was 13 (22.8%), 41 (71.9%) and 2 (5.3%) respectively, whereas for group B it was 52 (91.2%), 5 (8.8%) and zero respectively. The difference in frequency was significant (p<0.001). Conclusion: Rectal diclofenac leads to better pain relief as compared to intramuscular tramadol in Manual Vacuum Aspiration.