Anesthetic suppository after childbirth

Nine months a woman carries her baby, anxiously awaiting the onset of the crucial moment - the birth of a child. Childbirth is a natural process, accompanied by a tremendous burden on the female body. Hormonal changes, physical pain and psychological stress are factors that invariably accompany the woman in childbirth. If the birth is the first, or repeated and rapid, a large child or obstetrician-gynecologist is not qualified to lead natural childbirth, complications arise in the form of internal and external cracks, ruptures in the vagina and perineum. The causes of these complications can also be underdevelopment of the vagina (narrow and short), illiterate use of obstetric forceps or vacuum extractor. Gaps are eliminated by stitching. In consequence, there may remain rough and painful scars that interfere with normal life. To prevent craniocerebral injuries of the infant and spontaneous ruptures of the vagina or perineum of the mother in childbirth, obstetric surgical tactics of labor management-an episiotomy. The perineum and the posterior wall of the vagina are dissected surgically. After the birth of the child, the edges of the incisions are joined and fixed with sutures.

When applying sutures in the crotch and vagina, you must carefully observe the rules of personal hygiene. Carry out measures aimed at preventing the pathogenic microflora from entering the seams and their swelling.

After giving birth, a woman may be bothered by pain and bleeding from injured hemorrhoids. This fact negatively affects the general condition of the mother in childbirth.

In puerperia intensive, persistent aches and pains in the perineum, low back pain after epidural anesthesia, pain in the anus and rectum after traumatizing the hemorrhoids, pain associated with delivery by caesarean section. A few weeks after the birth, the reproductive organs of the woman will return to normal. The uterus will contract, the soreness and puffiness of the perineum will pass and the mother and child will be able to enjoy communication with each other.

The pain factor negatively affects the regulation of the lactation process and the psychological state of the parturient child. The woman in the postpartum period is emotionally unstable and is in the strongest stress state, so a very important point will be the relief and elimination of the pain syndrome. To determine the type of analgesia (tablets, suppositories, injections), a specialist consultation is necessary. The attending physician will be able to adequately assess whether the benefit to the mother exceeds the potential risks of developing side effects in the newborn. Self-medication is unacceptable and has unpredictable and dangerous consequences. Rectal and vaginal suppositories can be used for anesthesia in Puerperia. They have both general and local anesthetic effects. Have anti-inflammatory effect. The names of analgesic suppositories allowed in the postpartum period are the following: Ketorol, Ketanol, Diclof, Diclofenac, Voltaren.

The most effective analgesic suppositories with success used in gynecological practice after delivery are the rectal suppository Diclofenac.

[1], [2], [3]

Indications of the anesthetizing suppositories after delivery

• Degenerative, destructive post-traumatic acute and chronic diseases.
• To eliminate oedematous-pain syndrome in the postoperative period.
• Gynecological practice: postpartum period, algodismenorea (diclofenac is able to eliminate pain syndrome and reduce the severity of blood loss).
• Neurology: elimination of acute pain in the back, migraine headaches, with tunnel syndromes.

[4], [5]

Pharmacodynamics

The active substance is sodium diclofenac. Refers to a group of non-steroidal anti-inflammatory drugs, is an effective multifunctional tool used in various branches of medical practice. Diclofenac has antiflogistic, analgesic and antipyretic effects.

Anti-inflammatory activity is based on suppression of the synthesis of bioactive compounds that accompany any inflammatory process in the body. Diclofenac significantly inhibits the secretion of substances that contribute to the emergence of an active inflammatory process, increased body temperature and pain.

The analgesic effect is explained by the ability of diclofenac sodium metabolites to influence the intensity of pain sensations, affecting the degree of irritation of certain receptors in the brain. In addition to suppressing the central signal, the appearance of pain drug affects the sensitivity of peripheral receptors, that is, it can be concluded that the drug Diclofenac achieves an anesthetic effect by interrupting the pulse in the different levels of the chain of pain signal.

[6], [7], [8], [9], [10], [11]

Pharmacokinetics

With rectal administration, the active active ingredient is quickly and completely absorbed into the bloodstream. After 0.5-1 hour after the administration, the concentration of the substance in the blood reaches a maximum level, which is much faster than with the oral intake of tableted sodium diclofenac (2-4 hours). It is transformed by the liver into active metabolites that affect the receptors of neuronal tissue. Inactive derivatives of diclofenac are excreted mainly by the kidneys (65%) and part by the intestine (30%).

In patients with chronic functional hepatitis and cirrhotic changes in the liver, with a violation in the work of the kidneys, no pharmacokinetics were observed.

With a moderate degree of disturbance of the filtration function of the kidneys, it is distinguished by an elongation of the clearance time. Diclofenac in the body does not cumulate. Penetrates into breast milk and synovial fluid.

[12], [13], [14],

Dosing and administration

Diclofenac in the form of rectal suppositories has advantages over the enteral and parenteral route of administration of the drug. Suppositories do not cause complications when injected (infiltrates, abscesses) and are absorbed much faster than tablet forms. Rectal suppositories do not have an irritant effect on the mucous membranes of the stomach and duodenum, the barrier function of the liver affects the activity of the drug less intensively. The daily dose should be calculated by the attending physician depending on the problem (not more than 150 mg / day).

Before using suppositories it is recommended to clean the intestines so that the main active substance is absorbed. Release the suppository from the contour plastic packaging. It is necessary to inject the suppository into the anus as deeply as possible. It is advisable to carry out this manipulation for the night or after the introduction should be in the lying position 20-30 minutes. In obstetric-gynecological practice (caesarean section and for analgesia after childbirth), diclofenac is recommended in the case when the benefit to the mother exceeds the possible risks for the child. Self-medication in obstetrics can significantly worsen the condition of the mother. Therefore, the choice of means and methods of anesthesia after childbirth should be entrusted to a qualified physician.

The daily dosage according to the instructions is: 1 suppository (Diclophenacum 0.1 g) rectally once.

The duration of the course of treatment and the dose of the drug are determined by the doctor individually, taking into account the dynamics and tolerability of therapy.

[17],

Contraindications

• hypersensitivity to diclofenac or other non-steroidal drugs (possibly an "aspirin triad");
• destructive-inflammatory changes in the mucous membrane of the upper gastrointestinal tract (erosion, gastric and duodenal ulcers in the acute phase of manifestations or accompanied by obvious or latent bleeding);
• exacerbation of proctitis and paraproctitis;
• exacerbation of the course of hemorrhoids, accompanied by bleeding;
• violation of hematopoiesis of unexplained genesis;
• conditions that occur with oppression of hematopoiesis - aplastic or hypoplastic anemia, thrombocytopenia;
• acute liver disease;
• acute kidney disease, accompanied by a deep degree of impaired filtration capacity;
• children's age till 16 years;
• pregnancy (especially III trimester);
• lactation period (if necessary long-term treatment with diclofenac, breast-feeding recommended stopping);
• the presence of confirmed hyperkalemia.

The risk factors in which the appointment and dose of diclofenac to a doctor should be selected especially carefully:

• Age 65 years.
• Hypertonic disease.
• Moderate and deep degree of chronic renal failure with impaired filtration capacity.
• Chronic destructive diseases of the liver.
• Heart failure.
• Reception of alcohol.
• Smoking.

[15], [16],

Side effects of the anesthetizing suppositories after delivery

Usually the drug is well tolerated by patients. With rectal administration, local reactions may occur: itching, burning, pain during defecation, mucous discharge with an admixture of blood, swelling at the injection site;

• hematopoietic system - thrombocytopenia, leukocytopenia, agranulocytopenia;
• CNS - vertigo, cephalalgia, tremor of hands, convulsions;
• nervous system - irritability, anxiety, insomnia, depression, disorientation;
• cardiovascular system - tachycardia, chest pain, increased blood pressure;
• respiratory - shortness of breath, bronchial asthma;
• immune system - hypersensitivity, anaphylactic shock, Quincke's edema;
• Gastrointestinal tract - abdominal pain, nausea, vomiting, flatulence, decreased appetite, proctitis, exacerbation of ulcerative colitis, constipation, exacerbation of hemorrhoids, the emergence of HCC;
• digestive organs - pancreatitis, toxic hepatitis with an increase in the level of transaminases and bilirubin, acute liver failure;
• skin - itching, rash, urticaria, erythema multiforme, photosensitivity;
• excretory system - acute renal failure, the appearance of blood and protein in the urine, the emergence of acute nephrotic syndrome;
• the manifestation of local reactions - irritation in the place where the drug was used.

Side effects when using diclofenac occur during long-term use or use of high doses.

If after applying the suppository, any of the listed side effects appeared or worsened, it is necessary to inform the attending physician of this immediately.

Overdose

Symptoms of sodium diclofenac overdose - discomfort in the epigastric region, vomiting, HCC, diarrhea, dizziness, tinnitus.

Exceeding the recommended dose can adversely affect the work of the kidneys (development of nephrotic syndrome) and toxic damage to the liver.

Treatment: there is no antidote to sodium diclofenac. Treatment of an overdose consists in maintaining the vital vital functions of the body and symptomatic therapy. The use of hemodialysis and forced diuresis have no effect due to a significant degree of binding of diclofenac and its metabolites to blood plasma proteins.

[18]

Interactions with other drugs

With synchronous use of suppositories "Diclofenac" with:

• lithium-digoxin-containing drugs increases the level of their concentration in the blood;
• diuretic and hypotensive decreases their effectiveness;
• potassium-sparing diuretics - potassium levels in the blood are likely to rise;
• glucocorticoids - significantly increases the risk of developing FGM;
• cyclosporine, methotrexate significantly increases their toxic effect on the liver;
• anticoagulants - a constant control of blood clotting is necessary;
• derivatives of quinol - there may be convulsions;
• hypoglycemic drugs have almost no effect on their effectiveness, but it is necessary to monitor the concentration of glucose in the blood;
• alcohol - manifested by severe toxic intoxication, irregular blood pressure, slowed metabolism and elimination of both substances, disorders in the work of the nervous system.

[19], [20]

Storage conditions

Suppositories are stored in a cool, dark place, at an air temperature of +8 ^о С - + 15 ^о С (in the refrigerator). Do not allow the heating of plastic individual packages. Suppositories in packages with broken integrity are not usable and can be infected. Keep away from children.

[21], [22], [23], [24]

Shelf life

Shelf life is 2 years. Do not use at the end of the period indicated on the factory original carton.

[25], [26], [27], [28],