Diclofenac For Pain Relief Research Articles

Pentazocine, a Kappa-Opioid Agonist, Is Better Than Diclofenac for Analgesia in Acute Pancreatitis: A Randomized Controlled Trial.

The ideal analgesic is not known for patients with acute pancreatitis (AP). Concerns have been raised about serious adverse effects of opioid analgesics increasing the severity of AP. We hypothesized that nonsteroidal anti-inflammatory drugs might be better analgesics because of their anti-inflammatory effect. Our objective was to compare pentazocine, an opioid, and diclofenac, a nonsteroidal anti-inflammatory drug, for adequate analgesia in patients with AP. In a double-blind randomized controlled trial, patients with AP were randomized to either intravenous diclofenac 75 mg or pentazocine 30 mg. Fentanyl was given as a rescue analgesic through a patient-controlled analgesia pump. Primary outcome was pain relief measured objectively by the dose of fentanyl required as the rescue analgesic, pain-free period, and numbers of effective and ineffective demands of fentanyl. Secondary outcome was adverse events. Fifty patients were randomized, 24 to the pentazocine group and 26 to the diclofenac group. Baseline characteristics were comparable between the groups. Pentazocine was found to be better than diclofenac in terms of significantly lower dose of the rescue analgesic (fentanyl) required (126 μg (interquartile range (IQR) 65-218 μg) vs 225.5 μg (IQR 133-427 μg); P = 0.028) and longer pain-free period (31.1 ± 8.2 vs 27.9 ± 6.6 hours, P = 0.047). The number of effective and ineffective demands was lower in the pentazocine group compared with the diclofenac group (11.5 (IQR 8-15) vs 16 (IQR 13-20), P = 0.098) although not statistically significant. Adverse events were similar between the groups. Pentazocine, a kappa-opioid receptor agonist, was significantly better than diclofenac for pain relief in AP (Trial registration number: CTRI/2016/09/007326).

Pentazocine, a Kappa-Opioid Agonist, Is Better Than Diclofenac for Analgesia in Acute Pancreatitis: A Randomised Controlled Trial

Background: The ideal analgesic is not known for patients with acute pancreatitis (AP). Concerns have been raised about serious adverse effects of opioid analgesics increasing the severity of AP. We hypothesized that non-steroidal anti-inflammatory drugs (NSAIDs) might be better analgesics due to their anti-inflammatory effect. Our objective was to compare pentazocine, an opioid, and diclofenac, an NSAID for adequate analgesia in patients with AP. Methods: In a double-blind randomised controlled trial, patients with AP were randomised to either intravenous Diclofenac 75 mg or Pentazocine 30 mg. Fentanyl was given as a rescue analgesic through a patient controlled analgesia pump. Primary outcome was pain relief measured objectively by the dose of fentanyl required as rescue analgesic, pain-free period, and numbers of good and bad demands of fentanyl. Secondary outcome was adverse events. Findings: Fifty patients were randomised: 24 to pentazocine group and 26 to diclofenac group. Baseline characteristics were comparable between the groups. Pentazocine was found to be better than diclofenac in terms of significantly lower dose of rescue analgesic (fentanyl) required [126 μg (range 0-960 μg) vs. 225·5 μg (range 0-810 μg); p = 0·028], and longer pain-free period (31·1±8·2 hours vs. 27·9±6·6 hours, p=0·047). The number of good and bad demands was lower in the pentazocine compared with diclofenac group [11·5 (range 0-92) vs. 16 (range 0-85), p=0·098] although not statistically significant. Adverse events were similar between the groups. Interpretation: Pentazocine, a kappa opioid receptor agonist, was significantly better than Diclofenac for pain relief in AP. Clinical Trial Number: (Trial registration number: CTRI/2016/09/007326) Funding Statement: The authors state: None, and It was an investigator initiated study. Declaration of Interests: None of the authors have any conflict of interest. Ethics Approval Statement: The study was approved by the institutional ethics committee (IECPG 69/27·11·2015). An informed written consent was taken from the participants.

445 - Comparison of Pentazocine with Diclofenac for Pain Relief in Patients with Acute Pancreatitis: A Randomized Controlled Trial

445 - Comparison of Pentazocine with Diclofenac for Pain Relief in Patients with Acute Pancreatitis: A Randomized Controlled Trial

Pentazocine Alone Versus Pentazocine Plus Diclofenac for Pain Relief in the First 24 Hours after Caesarean Section: A Randomized Controlled Study.

Postoperative pain is one of the main postoperative adverse outcomes following caesarean section. Its management still remains a challenge especially in a low resource setting. To compare the efficacy of intramuscular pentazocine alone and combined intramuscular pentazocine with diclofenac for pain relief within 24 hours after caesarean section. This was a double blind randomized control study of post caesarean section pain management of 140 participants between April and December, 2015 at the Federal Teaching hospital, Abakaliki. Inclusion criteria involved consenting and low risk parturients who had caesarean section under spinal anaesthesia. The participants were randomly grouped into Pentazocine-Placebo (PP) group and Pentazocine-Diclofenac (PD) group. The PP group received pentazocine 30 mg every 4 hours for 24 hours and 3 milliliters of water for injection as placebo 12 hourly for 24 hours while the PD group received pentazocine 30 mg every 4 hours and diclofenac 75 mg every 12 hours for 24 hours. The level of pain control was assessed using the Visual Analog Scale (VAS). The data was analysed with IBM SPSS version 20.0. The level of significance was set at < 0.05. The use of PD for 24 hour post caesarean section analgesia achieved better pain relief, faster onset of postoperative ambulation, bowel sound auscultation and oral feeding than the use of PP (p-value ≤0.002). However, the use of PD is more expensive than PP (p-value =0.0001). There was no difference between the two groups of participants on the passage of flatus and duration of hospital stay (p-value≥0.05). The use of PP was associated with more maternal side effects (p-value=0.009). There was no difference on the level of satisfaction between the two groups of participants (p-value≥0.05). The use of PD for post caesarean section analgesia is more effective in achieving a satisfactory pain relief and has less side effects.

Preventable critical incidents in anaesthesia: a retrospective analysis of two anaesthetic mishaps after inadvertent drug administration

Drug errors in anaesthesia can be life threatening. In this article, we report two such mishaps of wrong drug administration. A 12-year-old boy was unintentionally injected atracurium instead of diclofenac for pain relief. He became apneic and did not respond to verbal commands. His trachea was intubated and he was mechanically ventilated. After 40 minutes of sedation, mechanical ventilation and stable hemodynamics, extubation of trachea was done. Another patient was also accidentally injected atracurium in the operating room to provide post-operative analgesia at the end of the surgery. Both the cases had favourable outcome because of a high degree of suspicion, prompt diagnosis and early intubation; very crucial steps in such scenarios. This article concludes that the labels should be carefully checked before drug administration, for the right drug and adequate dosage at the right time.

Invited Comment on “Comparison of Analgesic Effect Between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy”

We read with interest the research article by Mogadam AY, Fazel MR and Parviz S entitled “Comparison of analgesic effect between gabapentin and diclofenac on postoperative pain in patients undergoing tonsillectomy” (1). The results suggested that diclofenac and gabapentin reduce both post-operative pain and opiod consumption without any obvious side effects. The authors have been very methodical and have presented a very detailed account of the research process. However, some studies have stated that oral tramadol can deliver the similar analgesic effects as oral diclofenac for pain relief after tonsillectomy and thereby, avoiding the adverse effects of nonsteroidal anti-inflammatory drugs (2). A study has also suggested that preoperative tramadol in lower doses could be used not only at induction of anesthesia in tonsillectomy of children as an alternative to propofol anesthesia but also postoperative analgesia in only early period (3). Although studies have stated the premedication with gabapentin decreased post-tonsillectomy pain, it did not show any significant reduction in post-operative nausea and vomiting (PONV) (4, 5). A recent systematic review on gabapentin revealed that it effectively reduces post-operative pain, opioid consumption, and opioid-related adverse effects after surgery (6). A study has stated that preoperative 600 mg of gabapentin did not cause any reduction in post-operative pain after hip arthroplasty whereas another study conducted with the same dose of gabapentin showed significant reduction of postoperative pain after total mastectomy and axillary dissection (7, 8). Although there have been numerous conflicting outcomes in the recent studies regarding the preemptive use of diclofenac and gabapentin in reduction of postoperative pain and side effects such as nausea and vomiting, the researchers have made a very systematic effort to study these drugs.

A Randomized Controlled Study Comparing Subcutaneous Pethidine with Oral Diclofenac forPain Relief after Caesarean Section

It is important to provide effective postoperative analgesia following a Caesarean section because mothers wish to be pain-free, mobile and alert while caring for their babies. The role of regular oral diclofenac as postoperative analgesia was evaluated in a randomized controlled study and it was compared to the established method of parenteral pethidine. Forty healthy women scheduled for elective Caesarean section under spinal anaesthesia with 2-2.5 mg of heavy bupivacaine 0.5% were randomized to receive either 75 mg of oral diclofenac twice daily or 1 mg/kg of subcutaneous pethidine every 8 hourly. Efficacy of pain relief (visual analogue score), patients' satisfaction and side effects such as sedation, nausea and vomiting were recorded for three days. The demographic variables were similar in both groups. Pain relief was adequate and comparable in both groups with similar mean visual analogue score during the second and third day of the study period.However, on the first postoperative day, 60% of the diclofenac group population required rescue medication consisting of subcutaneous pethidine in order to achieve the same pain scores as those in the pethidine group who did not require any rescue medications. Women who received oral diclofenac reported lower sedation and higher overall satisfaction. The incidence of nausea and vomiting was similar in both groups. This concluded that although oral diclofenac 75mg twicedaily may not be superior to the traditional method of subcutaneous pethidine for pain relief following caesarean section, it can still be used alone as an alternative, as it has other benefits of a non-opioid analgesia.

A randomized trial of pain relief in termination of pregnancy in South Africa

The aim of this prospective trial was to evaluate and compare paracervical block with diclofenac for pain relief during manual vacuum aspiration (MVA) for surgical termination of pregnancy. Participants were randomized into three groups, viz. group (i) diclofenac 75 mg intramuscularly (i.m.) 30 min before the procedure; (ii) diclofenac 75 mg i.m. 30 min before the procedure, together with local infiltration of the cervix with lignocaine 1% (10 mL); (iii) diclofenac 75 mg i.m. 30 min before the procedure together with local infiltration of the cervix with lignocaine 1% (10 mL) and paracervical block with lignocaine 1% (5 mL). There was a significant difference in pain scores during the procedure between groups (i) and (ii) (P < 0.001), and between groups (i) and (iii) (P < 0.001) in pain scores during the procedure. There was no difference in pain score between groups (ii) and (iii) (P = 0.144). Post procedure analysis of pain score also showed significant difference between group (i) on one hand, and groups (ii) and (iii) (P < 0.001), but no significant difference between groups (ii) and (iii)(P = 0.029). The local anaesthetic infiltration of the cervix in combination with diclofenac or together with diclofenac and paracervical block provides better pain relief during and after the MVA.

Diclofenac for pain relief after arthroscopy: a comparison of early and delayed treatment

The effect of diclofenac on pain after arthroscopy of the knee joint was investigated in 64 patients. The aim of this double-blind, placebo-controlled, randomised study was to compare administration before surgery with delayed treatment. The effect on postoperative pain was evaluated by means of a Visual Analogue Scale and recording of the need for additional analgesics postoperatively. After surgery, hourly assessments were performed within 6 h after the anaesthetic block (approximately 5 h after start of surgery), and on the morning after surgery. Both treatment with diclofenac before surgery and delayed treatment were superior to placebo concerning pain scores within 6 h after onset of anaesthesia (P < 0.0065 and P < 0.0005, respectively). On the morning after surgery, only delayed treatment was superior to placebo (P < 0.02). No differences in pain scores were evident between the different groups treated with diclofenac. No differences in the need for additional analgesics were found.