Abstract:
Manual Vacuum Aspiration using paracervical block is commonly employed for
management of first trimester miscarriage. Opioids like tramadol and non-steroidal anti-inflammatory
drugs like diclofenac are employed in addition to paracervical block for analgesia. This study was
conducted to compare efficacy of rectal diclofenac sodium versus intramuscular tramadol for pain relief
in Manual Vacuum Aspiration. Method: This randomized controlled trial was conducted at Mother and
Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad from 21 January to 20 July 2017.
A sample size of 114 was calculated, 57 in each group. In Group A, patients received injection tramadol
100 mg intramuscularly 20 minutes before Manual Vacuum Aspiration. In Group B patients received
diclofenac suppository 100 mg rectally 60 minutes before procedure. Within three minutes of completion
of procedure patients were asked to rate their pain scores on Visual Analogue Scale. Results: Both
groups were comparable in terms of age, parity and gestational age. The mean pain score of Group A
(intramuscular tramadol) was 5.05±0.72 whereas that for Group B (diclofenac suppository) was
2.88±0.85 (p<0.001). Frequency of patients for group A in mild, moderate and sever pain categories was
13 (22.8%), 41 (71.9%) and 2 (5.3%) respectively, whereas for group B it was 52 (91.2%), 5 (8.8%) and
zero respectively. The difference in frequency was significant (p<0.001). Conclusion: Rectal diclofenac
leads to better pain relief as compared to intramuscular tramadol in Manual Vacuum Aspiration.
