MANAGING LABOR BACKACHE: A COMPARATIVE ANALYSIS OF STERILE WATER INJECTIONS AND DICLOFENAC

DR SIDRA RAUF , DR MUSSRAT BATOOL , DR NOSHEELA JAVED, DR SHIRZA SHARAFAT ALI , DR TOOBA MAHRUKH , DR RANI BUSHRA SAEED

Background: Severe back pain is a common and distressing complaint during childbirth. This study aimed to compare the efficacy, safety, and patient satisfaction of intradermal sterile water injections versus intramuscular diclofenac for the management of severe back pain during the first stage of labor.

Method: This prospective, comparative interventional study reviewed findings between June 2024 and December 2024 at the Department of Obstetrics and Gynaecology, Mother and Child Hospital, Pakistan Institute of Medical Sciences, Islamabad. Two cohorts of primigravida women (n=150 each) experiencing severe labor back pain (Visual Analogue Scale [VAS] score ≥ 7) were included. Group A received four intradermal sterile water injections at sacral points; Group B received a single 75 mg intramuscular injection of diclofenac sodium. The primary outcome was pain intensity, measured via VAS at baseline and at 15, 60, and 120 minutes post-intervention. Secondary outcomes included maternal satisfaction and adverse effects.

Results: Both interventions resulted in a significant reduction in back pain. The sterile water injection group experienced a more rapid onset of pain relief, with the mean VAS score decreasing from a baseline of 9.1 to 3.5 within 15 minutes. The diclofenac group showed a more gradual reduction, from 8.9 to 5.5 in the same timeframe. The analgesic effect was sustained for up to two hours in both groups. Maternal satisfaction was significantly higher in the sterile water injection group (92%) compared to the diclofenac group (75%). The only adverse effect noted was a transient, moderate sting at the injection site for the sterile water group.

Conclusions: Both sterile water injections and intramuscular diclofenac are effective in reducing severe back pain during labor. However, sterile water injections offer a more rapid onset of action, a higher degree of patient satisfaction, and a superior safety profile as a non-pharmacological intervention. Given the potential systemic risks associated with diclofenac use in pregnancy, sterile water injections represent a preferable first-line option for managing labor-related backache.