Effect of multimodal analgesia with diclofenac sodium on cognitive function following radical resection for colon cancer in elderly patients

Abstract

Objective To evaluate the effect of multimodal analgesia with diclofenac sodium on cognitive function following radical resection for colon cancer in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 65-80 yr, weighing 45-85 kg, scheduled for elective open sigmoidectomy under general anesthesia, were divided into control group and test group by a random number table method with 30 patients in each group.In test group, diclofenac sodium suppository was administrated rectally before surgery and placed at about 2 to 3 cm above the anal dentate line, diclofenac sodium suppository 50 mg was given at 2 h before surgery and 4 h after surgery, followed by administration once every 12 h until 2 days after surgery.Patient-controlled intravenous analgesia was performed after operation, dezocine 5 mg was intravenously injected when VAS score was more than 4 points within 48 h after surgery.The concentrations of serum interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) were measured by enzyme-linked immunosorbent assay before surgery (T0) and at 2, 6, 12, 24 and 48 h after surgery (T1-5). The postoperative requirement for rescue analgesia, postoperative analgesia satisfaction score, time of passing the first flatus and first postoperative off-bed time were recorded.Cognitive function was assessed at 1 day before surgery and 7 days after surgery, and the occurrence of postoperative cognitive dysfunction was recorded. Results Compared with control group, the serum concentrations of IL-6 at T2-5, IL-8 at T1-5 and TNF-α at T2-4 were significantly decreased, the requirement for rescue analgesia and incidence of postoperative cognitive dysfunction were decreased, and the time of passing the first flatus and first postoperative off-bed time were shortened in test group (P<0.05). Conclusion Diclofenac sodium for multimodal analgesia can improve cognitive function following radical resection for colon cancer in elderly patients. Key words: Diclofenac; Analgesia; Cognition disorders; Colonic neoplasms; Aged