A Comparative Study of Intravenous Diclofenac and Combination of Intravenous Paracetamol with Intravenous Diclofenac for the Postoperative Pain Management

摘要

Context: The search for an ideal drug for post operative analgesia is ongoing. Paracetamol is commonly used drug for this purpose in different routes.Aims: To assess and compare the quality and duration of postoperative pain relief with intravenous Diclofenac and combination of intravenous Diclofenac and Paracetamol.Settings and Design: This prospective randomized comparative study was conducted in the department of anaesthesiology in a medical college & hospital.Methods and Material: The study subjects were 60 male patients, aged between 20 and 40 years, of American Society of Anesthesiology (ASA) grade I scheduled for inguinal hernia repair, under spinal subarachnoid block anaesthesia. They were randomly allocated to receive either 75mg of Diclofenac in 100ml of normal saline as intravenous infusion (Group D) or 75mg of Diclofenac in 100ml of normal saline followed by 1000mg of Paracetamol as intravenous infusion (Group DP). The cases were observed for pain intensity, time of first rescue anlgesia requirment & total doses of rescue analgesia requirement. The study subjects were also observed for any change in haemodynamic and respiratory parameters & adverse effects.Statistical analysis used: The data using SPSS 17 version. Data were expressed as Mean and Standard Deviation and data were also analysed by using Test of Association (chi-square test). ‘P’ value less than 0.005 & 0.0001 was considered as significant & highly significant respectivelly.Results: The pain score and number of doses of rescue analgesia requirement were significantly less in the DP group (p<0.001). The time of first rescue analgesia requirement was significantly shorter in the D Group. There were no differences in vital parameters & adverse reactions in between two groups.Conclusions: A combination of Diclofenac 75mg along with 1000mg of Paracetamol given as a slow intravenous infusion, for post operative pain relief, gives a better quality, longer duration of analgesia, with lesser number of rescue analgesia, compared to infusion of 75mg of Diclofenac alone. Introduction Postoperative pain is considered as a form of acute pain owing to surgical trauma with an inflammatory reaction, initiation of an afferent neuronal barrage. Post operative pain is an unpleasant sensory, emotional and mental experience which is precipitated as a result of surgery and isoften associated with autonomic, endocrine-metabolic, physiological and behavioral response. (1) Pain if inadequately relieved can result in various complications like atelectasis / pneumonitis/hypoxaemia, deep vein thrombosis, delayed recovery of bowel function, myocardial ischemia and infarction, urinary retention and residual psychological trauma. (2) Therefore it is important to totally relieve the patient from the pain sensation after surgery. (3) Various treatment modalities are now available for controlling postoperative pain which include intravenous opioids, patient –controlled analgesia, regional catheters and adjuvant therapies (cryotherapy, minor analgesics, and NSAIDs). Conversely, these approaches have lots of limitations and technical use which could limit its use. (4) Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the widely used drug class for the relief of pain and inflammation. They act by inhibition of prostaglandin synthesis. However, the uses of NSAIDs group of drugs have increased risk of gastrointestinal and cardiovascular complication as compared with non- NSAIDs use. Paracetamol is an opioid sparing, short acting analgesic, used orally, rectally and intramuscularly. The mechanism of action of paracetamol was unknown till recently, when two important researchers unequivocally demonstrated that the analgesic effect of paracetamol is due to indirect activation of cannabinoid receptors. (5, 6) Diclofenac is an NSAID used orally, rectally, and as deep intramuscular injection. A combination is available commercially in the oral form but not intravenously. Each of these analg