EFFECT OF DICLOFENAC INTRAMUSCULAR VS RECTAL SUPPOSITORY IN PATIENT PRESENTING WITH PAIN ABDOMEN IN EMERGENCY MEDICINE DEPARTMENT
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Keywords
Abdominal Pain; Analgesia; Diclofenac; Drug Administration Routes; Emergency Service, Hospital; Nonsteroidal Anti‐Inflammatory Agents
Abstract
Acute abdominal pain is a leading presentation in emergency departments, yet optimal non‐opioid analgesic strategies remain underexplored. Diclofenac sodium, a potent nonsteroidal anti‐inflammatory drug, may be administered via rectal suppository or intramuscular injection.
Aim: To compare diclofenac administered either through intramuscular or rectal route to relieve pain in patients with abdominal pain in the ED
Methods: The present study was a randomized, double‐blind, double‐dummy trial which included 120 adult ED patients with non‐traumatic abdominal pain (NRS ≥5) were allocated 1:1 to receive diclofenac 100 mg rectal suppository plus IM placebo or diclofenac 75 mg IM plus rectal placebo. Pain scores (NRS 0–10) were recorded at baseline and at 10-, 20-, and 30-minutes post‐administration. Adverse events, route‐specific tolerability (injection‐site pain, rectal irritation), and patient satisfaction (5‐point Likert scale) were captured. Statistical analyses employed paired t-tests for within‐group changes, independent t-tests for between‐group comparisons, and χ² tests for categorical outcomes; p < 0.05 was significant.
Results: Baseline pain was similar (rectal: 7.3 ± 1.9; IM: 7.2 ± 2.0; p = 0.82). Both routes achieved rapid pain reduction at 10 minutes (rectal: 4.9 ± 2.2, p < 0.001; IM: 5.3 ± 2.3, p < 0.01), and sustained declines at 20 minutes (rectal: 3.2 ± 1.8; IM: 3.5 ± 2.0; p = 0.59) and 30 minutes (rectal: 2.3 ± 1.5; IM: 2.5 ± 1.7; p = 0.64). Adverse events were infrequent (rectal: 10.0%; IM: 16.7%; p = 0.45). Injection‐site pain occurred in 13.3% of IM patients; rectal irritation in 6.7%. Mean satisfaction favored the rectal route (4.2 ± 0.8 vs. 3.8 ± 0.9; p = 0.045). Sixty percent preferred rectal administration (p = 0.13).
Conclusion: Rectal and intramuscular diclofenac provide rapid, sustained analgesia for ED abdominal pain with comparable safety. Higher patient satisfaction and preference for suppositories support their use as a non‐invasive alternative.
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Dr Bopanna C A
Assistant Professor, Dept. Emergency Medicine, KVG Medical College and Hospital, Sullia,
Dr Shankarachari S Mayachari
Post Graduate Student & Dept. Emergency Medicine, KVG Medical College and Hospital, Sullia,
Dr Harold Maxim Lewis
Professor and Head, Dept. Emergency Medicine, KVG Medical College and Hospital, Sullia,
Dr Chandan Kumar N R
Post Graduate Student, Dept. Emergency Medicine, KVG Medical College and Hospital, Sullia,
Dr Kevin Koshy Joseph
Post Graduate Student, Dept. Emergency Medicine, KVG Medical College and Hospital, Sullia,
Dr Rachitha R
Post Graduate Student, Dept. Emergency Medicine, KVG Medical College and Hospital, Sullia,
