Abstract
Background Diclofenac sodium is a non-steroidal anti-inflammatory agent commonly used to provide analgesia postsurgery. It is common clinical practice to administer a diclofenac suppository at induction to contribute to pre-emptive analgesia (PEA). Diclofenac takes up to 30 minutes to attain maximal plasma level after rectal administration.
Aim To compare post-operative analgesia in patients who received diclofenac 30–45 minutes preoperatively, or at induction of anaesthesia.
Methods A prospective, randomised, double-blind controlled trial in 157 patients undergoing varicose vein surgery. Group A (control) received a rectal placebo 30–45 minutes preoperatively, group B received diclofenac 100mg 30–45 minutes preoperatively and group C received placebo 30–45 minutes preoperatively and diclofenac 100mg at induction. Outcome measures were Visual Analogue Scores (VAS) and requirement for rescue analgesia.
Results Patients in group A had significantly poorer analgesia than patients in groups B and C. There were no significant differences in VAS values and requirements for rescue analgesia between groups B and C 3–4 hours and 18–22 hours postoperatively.
Conclusion For patients undergoing varicose vein surgery preoperative administration of rectal diclofenac significantly improves post-operative analgesia and this effect is independent of whether it is given at induction or 30– 45 minutes preoperatively.
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References
Code W. NSAIDs and balanced analgesia.Can J Anaesth 1993; 40: 401–5.
Ferreira SH. Peripheral analgesia: mechanisms of the analgesic action of aspirin-like drugs and opiate antagonists.Br J Clin Pharmacol 1980; 10: 237.
Dubner R. Neuronal plasticity and pain following peripheral tissue inflammation and nerve injury. In: Bond MR, Charlton JE, Woolf CJ, eds. Proceeding of the VIth World Congress on Pain. Amsterdam: Elsevier 1991; 263–76.
Woolf CJ. Recent advances in the pathophysiology of acute pain.Br J Anaesth 1989; 63: 139–46.
Reiss W, Stierlin H, Degen P et al. Pharmacokinetics and metabolism of the anti-inflammatory agent Voltaren.Scand J Rheumatol (Suppl) 1978; 22: 17–29.
Pavy T, Medley C, Murphy DF. Effect of indomethacin on pain relief after thoracotomy.Br J Anaesth 1990; 65: 624–7.
Dahl JB, Kehlet H. Non-steroidal anti-inflammatory drugs; rationale for use in severe postoperative pain.Br J Anaesth 1991; 66: 703–12.
Coderre TJ, Vaccarino AL, Melzack R. Central nervous system plasticity in the tonic pain response to subcutaneous formalin injection.Brain Res 1990; 535: 155–8.
Dickenson AH, Sullivan AF. Subcutaneous formalin- induced activity of dorsal horn neurones in the rat: differential response to an intrathecal opiate administered pre or post formalin.Pain 1987; 30: 349–60.
Yashpal K, Katz J, Coderre TJ. Effects of preemptive or postinjury intrathecal local anesthesia on persistent nociceptive responses in rats.Anesthesiology 1996; 84: 1119–28.
Dahl JB, Hansen BL, Hjortso N-C, Erichsen CJ, Moiniche S, Kehlet H. Influence of timing on the effect of continuous extradural analgesia with bupivicaine and morphine after major abdominal surgery.Br J Anaesth 1992; 69: 4–8.
Dierking G, Dahl JB, Kanstrup J, Dahl A, Kehlet H. Effect of prevs. postoperative inguinal field block on postoperative pain after herniorrhaphy.Br J Anaesth 1992; 68: 344–8.
Nordblah I, Ohlander B, Bjorkman R. Analgesia in tonsillectomy: a double-blind study on pre and postoperative treatment with diclofenac.Clin Otolaryngol 1991; 16: 554–8.
Dupuis R, Lemay H, Bushnelle MC, Duncan GH. Preoperative flurbiprofen in oral surgery: A method of choice in controlling post-operative pain.Pharmacotherapy 1988; 8: 193–200.
Buggy DJ, Wall C, Carton EG. Preoperative and postoperative diclofenac for laproscopic tubal ligation.Br J Anaesth 1994; 73: 767–70.
Murphy DF, Medley C. Preoperative indomethacin for pain relief after thoracotomy: comparison with post-operative indomethacin.Br J Anaesth 1993; 70: 298–300.
McQuay HJ. Pre-emptive analgesia. Br J Anaesth 1992; 69: 1–3.
Doyle E, Bowler GMR. Pre-emptive effect of multimodal analgesia in thoracic surgery.Br J Anaesth 1998; 80: 147–51.
Sisk AL, Grover RJ. A comparison of preoperative and postoperative naproxen sodium for suppression of postoperative pain.J Oral Maxillofac Surg 1990; 48: 674–8.
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Lyons, J., Niazi, A., Lowe, D. et al. A prospective, randomised trial of preoperative rectal diclofenac: Are we closing the gate after the horse has gone?. Ir J Med Sci 172, 112–114 (2003). https://doi.org/10.1007/BF02914493
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DOI: https://doi.org/10.1007/BF02914493