Abstract
The aim of this study was to assess the analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAIDs), administered as intramuscular diclofenac in comparison with intravenous paracetamol after transurethral resection of the prostate (TURP). Fifty men, aged 55 to 75 years, undergoing TURP at our hospital were included in this study. Patients were divided randomly and prospectively into two groups (25 patients in each group). Group I (NSAID) received 75 mg of diclofenac i.m. at the end of the operation followed by 75 mg of diclofenac i.m. for 24 hours (75 mg x 2 once a day = 150 mg/24 h) postoperatively. The other group (Group II) consisted of patients who received 1g/100 mL i.v. paracetamol 15 minutes twice daily as postoperative analgesia. Postoperative pain scores were evaluated at 30 minutes, 1, 2, 4 and 6 hours after administration of each analgesic, using a visual analogue scale (VAS). Furthermore, preoperative and postoperative hemoglobin (Hb) levels and hemostatic variables (bleeding time, prothrombine time and the international normalized ratio, i.e. the ratio of a patient's prothrombin time to a normal [control] sample) were recorded in all patients. The pain score changes during a 4 hour period between the two groups was similar (p = 0.162). Thirty minutes after surgery, pain scores were high (> 3 cm) in both groups and without differences between groups (p = 0.11) but 6 hours after surgery, pain scores were significantly higher with paracetamol compared to diclofenac (p < 0.05). No significant difference was observed between the groups regarding the amount of resected tissue, operating time, preoperative-postoperative Hb levels and hemostatic variables. In the both groups, no patient required blood transfusion postoperatively. NSAIDs are not a contraindication to TURP and should be used for the control of postoperative pain if indicated.
Highlights
Pain is a common symptom after endoscopic urologic surgery, and the need for effective pain management is obvious
A total of 50 patients were randomized into two groups, parenteral diclofenac group (Group I, n = 25) and intravenous paracetamol group (Group II, n = 25)
No significant difference was observed between groups regarding the amount of resected tissue, operating time, preoperative-postoperative Hb levels and hemostatic variables (Table-1 and 2)
Summary
Pain is a common symptom after endoscopic urologic surgery, and the need for effective pain management is obvious. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for their potent antipyretic and analgesic effects. These drugs reduce pain after surgery by preventing the synthesis and release of prostaglandins at the site of surgical trauma by inhibition of cyclo-oxygenase (COX-2). COX-2 is expressed in tissues that are traumatized by surgery or pathology within 2-12 hours after injury [2,3]. The use of NSAIDs for analgesia after surgery is controversial because NSAIDs, through antiplatelet activity by inhibition of the other isoform of cyclo-oxygenase, may increase the risk of postoperative bleeding. There are no available reported data concerning pain relief and postoperative bleeding effects of NSAIDs immediately after transurethral resection of the prostate
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