Objectives: To assess the efficacy of Acetaminophen rectal suppository compared to suppository Diclofenac in women with postpartum perineal pain secondary to perineal trauma.

Methods: This study is carried out in 2 phases. In phase I, 250 patients were recruited and managed as standard hospital protocol where no analgesia will be provided during immediate post-perineal repair. In phase II, 700 pregnant women who fulfilled inclusion criteria were randomized into suppository acetaminophen 500 mg (Group A) or suppository diclofenac 50 mg (Group B). The suppository will be given immediately post-perineal repair. Data included social demographic, antenatal history, intrapartum details, perineal trauma details will be recorded. Pain scores (resting and dynamic) will be recorded before repair (baseline), immediate post-repair, 2^nd-3^rd hour post-repair, 5^th-6^th hour post-repair and upon discharge. Severity of pain was recorded on the basis of 11-point Visual Analogue Scale (0-10).

Results: All 3 groups showed no statistically significant difference in descriptive data including social demographic, antenatal characteristics, intra-partum details, baby’s birth-weight, types of perineal tears. When compare the mean pain score of treatment group with the control group, both acetaminophen and diclofenac group significantly reduced the mean pain score (resting and dynamic) during 2^nd-3^rd hour & 5^th-6^th hour post-perineal repair following childbirth. In phase II, Pain scores (PS) were similar in both treatment groups with no statistically difference. Baseline resting & dynamic PS for group A was 6.28±1.30, 7.84±1.09, and group B was 6.30±1.29, 7.78±1.10 respectively (p=0.84 for resting PS, p=0.47 for dynamic PS). For resting & dynamic PS at 2^nd to 3^rd hour post-repair was 1.4±0.66, 1.94±0.71 for group A and 1.32±0.71, 1.88±0.65 for group B (p=0.123 for resting PS, p=0.243 for dynamic PS). At 5^th to 6^th hour post-repair, the resting & dynamic PS was 0.73±0.50, 1.30±0.58 respectively for group A and 0.71±0.53, 1.36±0.56 respectively for group B (p=0.769 for resting PS, p=0.162 for dynamic PS).

Conclusion: Suppository acetaminophen showed comparable analgesia effectiveness in postpartum perineal pain-control following perineal repair when compared to suppository diclofenac. Since oral & intravenous analgesia always have an important issue associated with potential passage into breast milk, rectal route of analgesic administration may be a better option. Rectal route also results in faster pain relief and more effective upon local action. This study showed that suppository acetaminophen is a good option to consider in managing pain-control for post-partum post perineal repair.