European Journal of Anaesthesiology:
European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000
Schmidt, A.; Björkman, S.; Akeson, J.
Departments of Anaesthesia and Intensive Care, Heisingborg Hospital, Malmo University Hospital and Hospital Pharmacy, Malmo University Hospital, Sweden
Background and goal of study: Diclofenac is widely used for postoperative analgesia and has shown opioid-sparing effects, but the perioperative safety of this drug is controversial because of its effect on thrombocytes which might cause increased bleeding. This prospective investigator-blinded study was designed to compare the effects of preoperatively administered diclofenac in comparison to paracetamol on bleeding and pain in patients undergoing tonsillectomy.
Materials and methods: Eighty patients, aged 8-69 years, weighing 40-89 kg, were randomised to receive rectal diclofenac 25, 37.5 or 50 mg corresponding to 0.65-1.0 mg kg−1 or paracetamol 500, 750 or 1000 mg, corresponding to 13-20 mg kg−1 preoperatively. Pain was evaluated during the first 4 h postoperatively using the visual analogue scale (VAS). Pain score ≥4 was treated with meperidine i.v. 0.25 mg kg−1 in incremental doses until acceptable VAS scores were achieved. Perioperative bleeding was evaluated by measuring peroperative blood loss and also by recording drugs used to achieve haemostasis and by the incidence of reoperations.
Results: Pain scores or opioid consumption were not significantly different between the study groups. Anaesthetic and surgical management did not differ except for a significantly longer surgical time in the diclofenac group, 32 ± 16 vs. 25 ± 11 min (P = 0.024). Perioperative bleeding was significantly larger in the diclofenac group than in the paracetamol group, 1.9 (1.1-3.1) vs. 1.1 (0.7-2.0) mL kg−1 (P=0.007).
Conclusions: Rectal diclofenac given preoperatively offers no advantage over paracetamol with respect to postoperative analgesia in patients undergoing tonsillectomy, but instead it increases peroperative bleeding.
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Acute and chronic pain management