Comparison of Transdermal and Intravenous Diclofenac in Acute Post-operative Pain in Intertrochanteric Fractures

Abstract

Introduction: Early mobilization is the primary goal after operation of hip fracture in the elderly wherein the main impediment despite adequate fixation being surgical site pain. Prolonged post-operative recumbency due to pain could lead to various complications like venous thrombosis and cardio-pulmonary compromise. Over enthusiastic use of NSAIDs or opioids on the other hand can have its own set of complications. Hence this study was carried out to evaluate effectivity and safety profile of a commonly used drug, diclofenac via transdermal route in comparison to iv diclofenac. Methods: 30 patients meeting the study criteria were alternatively allocated to either groups of IV diclofenac and TD diclofenac. All patients were informed how to monitor post-operative pain on a VAS scale at 2,4,6 and 12 hour intervals. Group TD was applied Trans Dermal Diclofenac 100 mg patch, 1 hour prior to surgery and repeated at 12 hourly intervals. Group IV was given intravenous diclofenac 75 mg 1 hour prior to end of surgery and repeated at 12 hourly intervals. First rescue analgesic used was Intra Venous (IV) Paracetamol, if VAS was more than 6, if administered Its dosage and timing of administration was noted. IV tramadol was kept as a standby rescue analgesic. Results: both the groups were comparable with regards to age and ASA scores. Time to first rescue analgesia, IV Paracetamol, in group TD was 10.23±2.42 hours while that in group IV was 8.15±2.48 hours. It was statistically significant(p<0.05). None of our patients required IV tramadol. The mean VAS scores at 2, 4, 6 and 12 hours were lower in group TD in comparison to group IV. There were no significant side effects noted. Conclusion: We can conclude that transdermal diclofenac patch group patients had lower VAS scores at all measured intervals compared to IV diclofenac group and a significantly longer time of rescue analgesic use. Thus, it seems a safe and effective choice for post-operative analgesia in orthopaedic patients.><0.05) None of our patients required IV tramadol. The mean VAS scores at 2, 4, 6 and 12 hours were lower in group TD in comparison to group IV. There were no significant side effects noted. Conclusion: We can conclude that transdermal diclofenac patch group patients had lower VAS scores at all measured intervals compared to IV diclofenac group and a significantly longer time of rescue analgesic use. Thus, it seems a safe and effective choice for post-operative analgesia in orthopaedic patients.