Use of diclofenac sodium suppositories in post operative pain management

Introduction: Per rectal suppository administration of diclofenac sodium is commonly used for post-operative pain relief. This audit was conducted to assess whether, patients were informed of administration of diclofenac sodium suppository and to find out whether they were questioned about contraindications and cautions for its use. Method: Audit conducted during five consecutive days in general surgical wards (n=16) in National Hospital Sri Lanka, among 150 patients on post-operative day one or two. Data extracted from bed head tickets and an interviewer-administered questionnaire. Results: Mean age of the population was 48.15yrs (SD=15.91), 51.3% being males and 70.7% had received diclofenac sodium suppository post-operatively. Of them 92.5% were not informed prior to administration of the suppository. Majority were not questioned about peptic ulcers (50.9%), bleeding disorders (72.6%), allergy for non steroidal anti-inflammatory drugs -NSAIDs - (50.0%) and renal impairment (62.2%), which are contraindications for the drug. Among those given diclofenac, 12.3% had asthma, 2.8% coagulation defects, 17% ischaemic heart disease, 11.3% peptic ulcer, 31.1% hypertension, 1.9% allergy to NSAIDs, 0.9% heart failure, 5.75% renal impairment which are contraindications for use of NSAIDs and 12.3% were elderly. Conclusion: Majority of patients are administered diclofenac suppository without prior consent and a considerable proportion of them have contraindications to the drug. Recommendation: There is need for a guideline for prescription of diclofenac sodium suppositories in the post operative period.