Gbala Michael Olumide, Buraimoh Olubunmi Kazeem, Okeyemi Ajibade, Adeyeri Adetola Abayomi, Adeyemo Mathew, Olujobi Babatunde A, Durojaye Olajide Alfred, Daramola Alaba Olanrewaju, Akinsipe Catherine Iyabo, Okurumeh Ogheneovo Ifedayo, Adebisi Mathew Olumide and Adenikinju Wilson Shina
Background: caesarean section (CS) is a common surgical procedure requiring effective postoperative pain management. Opioids are frequently used, often in combination with non-steroidal anti-inflammatory drugs (NSAIDs). Nefopam, a non-opioid, non-NSAID analgesic, may offer an alternative.
Objective: To compare the analgesic efficacy of Nefopam versus Pentazocine for post-CS pain, and to assess their effects on hemodynamic status, and the incidence of apnea, nausea, and vomiting.
Materials and Methods: A prospective, randomized, double-blind study was conducted at University of Medical Sciences Teaching Hospital, Ondo State, involving 140 patients undergoing CS under spinal anesthesia. Patients were randomly assigned to receive either IM Nefopam (20 mg) or Pentazocine (30 mg) every 6 hours, along with IM Diclofenac (75 mg) and IV Paracetamol (1g). Breakthrough pain was treated with IV morphine (5 mg). Pain was assessed using the Verbal Rating Scale (VRS). Primary outcome was pain, while secondary outcome focused on patient satisfaction. Statistical analysis was performed using SPSS Version 22.
Results: Of 157 recruited patients, 140 were eligible (mean age 31.61±4.15 years). Both analgesic combinations were effective, with 100% of patients reporting no more than moderate pain. Nefopam resulted in higher patient satisfaction (64.3% "very satisfied") compared to Pentazocine (52.9% "satisfied"). VRS scores for static and dynamic pain decreased over 24 hours. No participants required rescue analgesia. Hemodynamic changes were minimal, with a significant difference in diastolic BP in the Nefopam group (P = 0.002).
Conclusion: This study compared intramuscular nefopam-diclofenac-paracetamol and pentazocine-diclofenac-paracetamol combinations for post-caesarean section pain. Both provided effective pain relief and high satisfaction, with minimal rescue analgesia. Pentazocine was more effective early, while nefopam showed better control over time. The findings support multimodal analgesia, with further studies needed in resource-limited settings.
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