Pentazocine versus pentazocine with piroxicam for postoperative pain relief after cesarean section: an open label, comparative study

Background: The concept of multimodal analgesia was introduced more than a decade ago as a technique to improve analgesia and reduce the incidence of opioid-related adverse events. The rationale for this strategy is the achievement of sufficient analgesia due to the additive or synergistic effects between different classes of analgesics. Objectives of the study was to compare the efficacy and safety of pentazocine and its combination with piroxicam in the management of post cesarean pain.Methods: Cases were randomly assigned to 2 groups of 30 cases each. One group received pentazocine 30mg and another; pentazocine 30mg + piroxicam 20mg. Injections were given intramuscularly, postoperatively after skin closure. Diclofenac 75mg was the rescue analgesia. Primary outcome measure was control of pain, assessed by visual analogue scale (VAS). Secondary outcomes were sedation and time to rescue analgesia. Safety of the drugs was assessed by adverse drug reactions. Data was analysed by student’s t test, analysis of variance and post-hoc test.Results: Multimodal group showed better analgesia compared to unimodal group (p<0001). Drowsiness was the main adverse effect in both treatment groups.Conclusions: Multimodal analgesic combination of pentazocine and piroxicam showed superior analgesic effect with better pain control and longer duration of action compared to pentazocine alone