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

Banapura Ambika, Mamatha K. R., Prabha P.


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.


Pentazocine, Piroxicam, Post-cesarean pain

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Buvanendran A, Kroin JS, Tuman KJ. Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor of pain management and recovery of function after knee replacement. JAMA. 2003;290:2411-8.

White PF, Sacan O, Tufanogullari. Effect of short term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery. Can J Anaesth. 2007;54:342-8.

Ashburn MA, Caplan RA, Carr DB. Practice guidelines for acute pain management in the perioperative setting. An updated report by the American Society of Anesthesiologists task force on acute pain management. Anesthesiology. 2004;100:1573-81.

WHO. Int [homepage on the Internet]. WHO’s cancer pain ladder for adults. World Health Organization; 2012 [cited July 28, 2013]. Available from: Accessed June 27, 2014

Henderson K. Pentazocine. Update in Anesthesia 2008; 24(1) Available from: Accessed July 22, 2014.

Olofsson CI, Legeby MH, Nygards EB, Ostman KM. Diclofenac in the treatment of pain after caesarean delivery. An opioid-saving strategy. Eur J Obstet Gynecol Reprod Biol. 2000;88(2):143-6.

Wilder-Smith CH, Hill L, Dyer RA, Torr G, Coetzee E. Postoperative sensitization and pain after Cesarean delivery and the effects of single IM doses of tramadol and diclofenac alone and in combination. Anesth Analg. 2003;97:526-33.

RobertsII LJ, Morrow JD. Analgesicc-antipyretic and antiinflammatory agents and drugs employed in the treatment of gout. In: Hardman JG, Limbard LE, Goodman gilman A. The pharmacological basis of therapeutics. 10th Ed. New York: Mc Grow Hill; 2001:713-714.

Mitra S, Khandelwal P, Sehgal A. Diclofenac-tramadol vs diclofenac-acetaminophen combinations for pain relief after caesarean section. Acta Anaesthesiol Scand. 2012;56(6).

Verstraete S, Van de Velde M. Post-cesarean section analgesia. Acta Anaesthesiol Belg. 2012;63(4):147-67.

Multimodal analgesia: its role in preventing postoperative pain. [cited 2017 Mar 6]. Available from:

Pain Management: A Fundamental Human Right: Anesthesia & Analgesia [Internet]. LWW. [cited 2017 Mar 6]. Available from:

Karen Henderson. Pentazocine. Update in Anaesthesia. Available from: Accessed February 12, 2013.

Raffa RB. Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther. 2001;26(4):257-64.

McQuay HJ, Carroll D, Watts PG, Juniper RP, Moore RA. Codeine 20 mg increases pain relief from ibuprofen 400 mg after third molar surgery. A repeat-dosing comparison of ibuprofen and an ibuprofen-codeine combination. Pain. 1989;37(1):7-13.

Sinatra RS. Acute pain management and acute pain services. In: Cousins MJ, Bridenbaugh PO, editors. Neural Blockade in Clinical Anesthesia and Management of Pain. 2nd Ed. Philidelphia: Lippincott-Raven; 1998:793-835.

Adeniji AO, Oluseyi OA. Randomized comparison of effectiveness of unimodal analgesia with multimodal analgesia in post-cesarean section pain management. Journal of pain research. 2013;6:419-24.

Kuti O, Faponle AF, Adeyemi AB, Owolabi AT. Pain relief in labour: A randomized controlled trial comparing pentazocine with Tramadol. NJOG. 2008;3(1):14-8.

Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. Am J Obstet Gynecol. 2002;186(5): S94-109.

Adamou N, Tukur J, Muhammad Z, Galadanci H. A randomised controlled trial of opioid only versus combined opioid and non-steroidal anti inflammatory analgesics for pain relief in the first 48 hours after Caesarean section . Niger Med J. 2014;55:369-73.