On-Demand Acetaminophen Versus Scheduled Diclofenac-Serratiopeptidase After Cesarean Delivery: A Randomized Controlled Trial

Background: Effective pain control after cesarean delivery supports maternal recovery, early mobilization, and newborn care. This study compared on-demand acetaminophen with scheduled diclofenac-serratiopeptidase for postoperative analgesia following cesarean delivery. Materials and methods: This assessor-blinded randomized controlled trial included 400 women undergoing cesarean delivery at a tertiary-care teaching hospital in India. Participants were randomized equally into a study group and a control group. Both groups received injectable diclofenac during the first 48 postoperative hours. Thereafter, the study group received oral acetaminophen 500 mg on demand, while the control group received oral diclofenac 50 mg with serratiopeptidase 10 mg twice daily for five days. Pain was assessed using a 0-10 pain scale. Analgesic consumption and adverse effects were also recorded. Results: The mean pain score at 48 hours was lower in the study group than in the control group (2.1±0.9 vs. 3.0±1.2; p<0.001). The study group also consumed fewer oral analgesic doses (4.2±1.5 vs. 5.8±2.0; p<0.001). A pain score below 4 was recorded in 176 (88%) participants in the study group and 154 (77%) in the control group (p=0.009). Gastric irritation was less frequent in the study group (3% vs. 10%; p=0.007), while nausea and vomiting were comparable. Conclusion: On-demand acetaminophen was associated with lower oral analgesic consumption and less gastric irritation. Further studies using standardized treatment and assessment timings are needed.