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

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 ۲۰۲۰ 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 ۱۴, ۲۰۲۵. Risk of bias was assessed using the Cochrane RoB ۲ tool. Meta-analyses were conducted using RevMan ۵.۴, and the quality of evidence was evaluated with GRADE.Results: Eleven articles were included in the systematic review, with nine RCTs involving ۱۵۷۷ 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 ۲۴ hours compared with placebo (SMD = −۱.۴۹, ۹۵% CI −۲.۴۵ to −۰.۵۳; p = ۰.۰۰۲) and oral diclofenac (MD = −۱.۶۴, ۹۵% CI −۲.۸۰ to −۰.۴۹; p = ۰.۰۰۵). No significant difference was observed compared with rectal indomethacin (MD = −۰.۸۹, ۹۵% CI −۲.۲۸ to ۰.۵۰; p = ۰.۲۱). 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.

کلیدواژه ها:

Diclofenac ، NSAIDs ، Rectal Suppository ، Episiotomy ، Pain