Effects of peri-operatively administered diclofenac and indomethacin on blood loss, bleeding time and plasma prostanoids in man.

Sixty-seven patients scheduled for gynaecological laparotomy were anaesthetized with enflurane and divided at random into three groups to investigate double blind the effects of diclofenac (21 pts), indomethacin (23 pts) and placebo (23 pts) on haemostasis. Of each group eight to ten patients were chosen at random for estimation of peri-operative concentrations of prostanoids in plasma (thromboxane B2, prostaglandin E2). The pre-operative loading dose was diclofenac 33.6 mg or indomethacin 25 mg, followed by infusion for 24 h of diclofenac 6.7 mg h-1 or indomethacin 5 mg h-1. A fourth group received balanced anaesthesia (21 pts) and served as an additional control group for estimation of bleeding tendency and blood loss. The groups matched statistically for duration of surgery, age, weight, and height. No significant differences were found for prostaglandin E2 values, operation time, intra-operative blood loss, bleeding time, and frequency of post-operative haematomas. The most frequent surgeons' complaint was of increased bleeding tendency with indomethacin (P less than 0.001). Thromboxane B2 values in plasma were increased 30 min (66%) and 24 h (30%) after beginning of surgery in the placebo group (P less than 0.025). Diclofenac and indomethacin totally abolished these increases. During infusion of the loading dose of indomethacin one patient developed bradyarrhythmia, which was easily treated. No other complications appeared.

RCT Entities:   Population Interventions Outcomes