BACKGROUND:Diclofenac sodium is a non-steroidal anti-inflammatory agent commonly used to provide analgesia post-surgery. 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 diclofenac30-45 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 100 mg 30-45 minutes preoperatively and group C received placebo 30-45 minutes preoperatively and diclofenac 100 mg 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 ofrectal diclofenac significantly improves post-operative analgesia and this effect is independent of whether it is given at induction or 30-45 minutes preoperatively.
RCT Entities:
BACKGROUND:Diclofenac sodium is a non-steroidal anti-inflammatory agent commonly used to provide analgesia post-surgery. 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 100 mg 30-45 minutes preoperatively and group C received placebo 30-45 minutes preoperatively and diclofenac 100 mg 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.
Authors: W Riess; H Stierlin; P Degen; J W Faigle; A Gérardin; J Moppert; A Sallmann; K Schmid; A Schweizer; M Sulc; W Theobald; J Wagner Journal: Scand J Rheumatol Suppl Date: 1978