This double-blind, randomized study was designed to evaluate the use of
indomethacin (
Indocid, MSD) following caesarean delivery performed under spinal anaesthesia. Thirty ASA I-II women presenting for elective caesarean were recruited. Spinal anaesthesia was performed in a standard manner using hyperbaric
bupivacaine,
fentanyl and
morphine. At the completion of surgery, subjects were administered two
rectal suppositories, followed by 12-hourly
suppositories for six doses (three days). The study group received 100 mg
indomethacin suppositories and controls were given placebo (Anusol). Data collected included Visual Analog Scale (VAS)
pain scores at rest and with movement, VAS scores for
nausea and itch, and
analgesic use. Demographic data were similar in the two groups. Median time to first
analgesia (TTFA) was nine hours in the control group v. 39.5 hours in the
indomethacin group (P < 0.003). Additional
analgesic requests throughout the postoperative period were less in women who received
indomethacin: 4 v 11 (P < 0.001). Women who received
indomethacin had significantly less
pain on the first postoperative day, especially on movement: mean VAS 1.4 v 5.1 (P < 0.00001). There were no reported adverse neonatal or maternal effects from the use of
indomethacin. Rectal
indomethacin use following caesarean delivery leads to significantly improved
pain relief compared with placebo. The combination of spinal
morphine and rectal
indomethacin leads to high-quality postoperative
analgesia.