A randomized controlled study of intramuscular acetaminophen- diclofenac versus acetaminophen-pentazocine for pain relief during manual vacuum aspiration in university of Maiduguri teaching hospital

The management of first trimester miscarriages using manual vacuum aspiration is a cheap, fast and safe surgical method of uterine evacuation. However, this procedure generate pain as a result of cervical manipulation, insertion of cannula and suctioning of uterine cavity. This pain quite often, is intolerable to the patient. Therefore, an effective pain management intervention is necessary to abolish this pain.

Aim: The aim of this study was to compare combined acetaminophen-diclofenac with acetaminophen-pentazocine for pain relief during manual vacuum aspiration in a randomised controlled study at the University of Maiduguri Teaching Hospital.

Objective: To determine and compare the effectiveness of combined acetaminophen-diclofenac versus acetaminophen-pentazocine for pain relief during manual vacuum aspiration.

Methodology: This was a triple-blind randomised controlled study, that compared the effectiveness of combined acetaminophen-diclofenac versus acetaminophen-pentazocine as a multimodal analgesia during manual vacuum aspiration. A total of 112 participants were randomised into two groups. Participants in group A (56 patients) received combined acetaminophen-diclofenac while participants allocated in group B (56 patients) received acetaminophen-pentazocine for pain relief during manual vacuum aspiration.

The primary outcome, measured the occurrence of mild or no pain during the procedure. Secondary outcome measured the need for rescue analgesia used during the procedure. The data was entered into SPSS version 20.0 (IBM, Armonk, NY, USA 2011) for statistical analysis.

Result: There was statistically significant difference in the effectiveness, when combined acetaminophen-pentazocine compared to combined acetaminophen-diclofenac was used during manual vacuum aspiration (P value=0.001). Majority 44(78.6%) of the participants in combined acetaminophen-pentazocine group experienced mild pain compared to 25(44. 6%) of participants in acetaminophen-diclofenac group and their mean pain scores were 2.8929(SD±1.1067) and 4.1786(SD±1.7899) respectively. When the mean pain scores of both groups were compared using the independent t-test, there was a statistically significant difference (P value = 0.001), with participants in combined acetaminophen-pentazocine group suffered less pain. 

Conclusion:  Combined acetaminophen-pentazocine as a form of analgesia during MVA was more effective when compared to combined acetaminophen-diclofenac.