The comparison of analgesic effects of Transdermal, Oral and Intramuscular Diclofenac Sodium in Early Postoperative Period in Laparoscopic Cholecystectomy Operations;The efficacy of various administration methods of Diclofenac Sodium in post-operative

Sedef Gülçin Ural,Ayşegül Özgök,Özlem Yener,Bahar Aydınlı,Tuncer Şimşek,Ali Ümit Yener

doi:10.12669/pjms.301.4140

Sedef Gülçin Ural, Ayşegül Özgök + Show 4 more

Open Access

https://doi.org/10.12669/pjms.301.4140

Copy DOI

Abstract

Objective: The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. Methods: Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete’s Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded. Results: Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. Conclusion: In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment.

Highlights

The first choice in the treatment of symptomatic gallbladder stone is laparoscopic cholecystectomy
Pain encountered following the laparoscopic cholecystectomy (LC) can be related to surgical manipulation, intraabdominal pressure applied during operation, irritation caused by CO2 administered intraperitoneally and irritation caused by bile leakage during the operation.[1,2]
Chi-square test was used in cross tables; average of ages of 3 groups, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), peripheral O2 saturation, Aldrete scores, mean push count were evaluated with One Way Variance Analysis (One-Way ANOVA); Kruskal-Wallis tests were used for Visual Analog Scale Pain Score (VAS) and Ramsey scores; SAP, DAP within the same group, whether HR and peripheral oxygen saturation differed between 7 different periods were evaluated in parametric data with Variance Analysis with Repeated Measurements (ANOVA with repeated measurements) and in non-parametric data with Friedman test

Summary

Introduction

The first choice in the treatment of symptomatic gallbladder stone is laparoscopic cholecystectomy. Pain encountered following the laparoscopic cholecystectomy (LC) can be related to surgical manipulation, intraabdominal pressure applied during operation, irritation caused by CO2 administered intraperitoneally and irritation caused by bile leakage during the operation.[1,2] Pain following LC is perceived in epigastrium, back and shoulders, and most frequently in upper abdomen.[3] Pain following the operation is one of the most important factors causing morbidity and mortality, two causes prolonging the hospital stay.[4]. Pre-emptive analgesia can both decrease the severity and duration of pain and can delay the pain.[5] Opioids, non-steroidal anti-inflammatory drugs (NSAID) are frequently used for this purpose. The aim of this study was compare the analgesic efficacy of oral, intramuscular and transdermal forms of diclofenac sodium in postoperative pain treatment in patients that will undergo LC, and their effect on postoperative tramadol consumption

Methods

Results

Conclusion