Comparison between preoperative rectal diclofenac plus paracetamol and diclofenac alone for postoperative pain of hysterectomy

To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy. Ninety female patients [American Society of Anesthesiologists [ASA] physical status I-II], scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8,16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A10 cm visual analog scale [VAS] was used to assess pain intensity at rest. In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower [13.9 +/- 2.7 mg] compared to diclofenac group [16.8 +/- 2.8 mg] and placebo group [20.1 +/- 3.6 mg] [p<0.05]. VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours [p<0.05]. There had been a significant difference between combination group and the two other groups in terms of the first request of morphine [p<0.05]. According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone

Pregnancy outcomes in women of advanced age

The aim of this study was to investigate prenatal and obstetrical outcome in mothers aged 40 years or older. A prospective comparative study was conducted for the women aged 40 years and over who delivered at 20 week's gestation or beyond from January 2004 to December 2005 at four Hospitals of Tehran University of Medical Sciences. For comparison, a control group of patients who were 20-29 years of age was considered. There were statistically significant increases in the rates of gestational diabetes, preeclampsia, caesarean section, breech presentation and stillbirth in women 40 years of age or older. There is a need to offer older women special counseling both before and after conception so that they become informed of the increased risks involved