BACKGROUND: Pain management following caesarean section still remains a challenge in our environment. Diclofenac suppository is an effective adjunct analgesic for post operative pain control. OBJECTIVE: To compare the efficacy and safety of combined rectal Diclofenac and intramuscular pentazocine with intramuscular pentazocine alone for post operative pain control following transverse lower segment caesarean section. DESIGN: A prospective randomized, placebo controlled trial. METHODOLOGY: A total of 120 low risk women scheduled for elective or emergency transverse lower segment caesarean section under spinal anaethesia with Bupivacaine, were randomized into two equal groups to receive either 50mg Diclofenac suppository 8 hourly for 24 hours or one Anusol suppository( the placebo) 8 hourly for 24 hours. Both groups received IM pentazocine 30mg 6hourly for 24 hours as the primary analgesic. The primary outcome measure was the proportion of patients with severe pains at 24 hours post operatively using the visual analogue rating scale. Secondary outcome measures were the time from surgery to ambulation, time from surgery to first passage of flatus, maternal satisfaction with analgesia, and presence of complications. Statistical analysis was performed using Student’s t-test for continuous variables and chi-square test or Fisher exact test (where appropriate) was used for categorical variables. P-value < 0.05 was considered significant.