Diclofenac Sodium Suppository Research Articles

The safety and efficacy of diclofenac sodium suppository as adjunctive opioids in the treatment of cancer pain: A prospective, multi-center, real-world study.

12055 Background: Cancer pain is one of the most common and unbearable symptoms for cancer patients (pts), seriously affecting their quality of life. Diclofenac sodium is a potent third-generation non-steroidal anti-inflammatory drug known for its significant analgesic, anti-inflammatory, and antipyretic effects. It is commonly used to treat different types of cancer pain. The objective of this study was to assess the safety and effectiveness of diclofenac sodium suppository when used alongside opioids for managing cancer pain in pts with solid tumors. Methods: In this prospective, multi-center, real-world study, we enrolled pts diagnosed with malignancy, Eastern Cooperative Oncology Group (ECOG) performance status of 0-3, numeric rating scale (NRS) score ≥ 3, and sustained cancer pain, who required additional analgesic medication were enrolled. Diclofenac sodium suppository is an anal administration suppository, prescribed once a day at a dosage of 50 mg. This study was conducted across 20 centers to observe the clinical characteristics of pain relief in pts with cancer pain . The primary endpoint of the study was to assess the safety of the medication. The secondary endpoints included evaluating the incidence of breakthrough pain (BP), NRS score, and Brief Pain Inventory (BPI) score on the second and sixth days of medication. Results: Of the 506 pts that were screened, 437 pts met the inclusion criteria. This included 10 pts who did not receive planned treatment and 2 pts who did not undergo post-baseline efficacy evaluation. Among the 425 pts in the full analysis set (FAS), 261 were man, and 169 (39.8%) had baseline BP. The mean age was 63.0±11.3 years old. Among 425 response-evaluable pts, compared to the baseline, the incidence of BP was reduced on the second (20.0% vs 39.8%), and sixth days (14.8% vs 39.8%) of medication and the difference was statistically significant ( P < 0.001, P < 0.001). For pts with baseline BP, 56.2% and 66.9% pts achieved BP relief on the second and sixth days of medication, respectively. From the baseline evaluation, the mean NRS scores for the three visits (baseline, second day, sixth day) were 5.28 ± 1.71, 3.73 ± 1.71, and 2.91 ± 1.88, respectively. The mean pain intensity at each visit was decreased compared to the baseline, and the difference was statistically significant ( P < 0.001, P < 0.001). 427 pts were included for safety analysis and 5 pts experienced any grade treatment emergent adverse events (TEAEs). All TEAEs were grade 1-2. TEAE leading to treatment discontinuation was occurred in one pt. Conclusions: This study demonstrated that diclofenac sodium suppository was an effective treatment option for managing breakthrough pain in patients with persistent cancer pain who required additional analgesic therapy. Moreover, diclofenac sodium suppository was found to be well tolerated when administered anally.

Efficacy of Palashgudavarti and Diclofenac Sodium Suppository in the management of Acute fissure in ano

Introduction: Parikartika is most common ano-rectal disorder. The text of parikartika is mentioned in Samhitas. In this disease there are symptoms such as bleeding per rectum, hard stools, burning sensation around anal region. In this trial, group A (n=30) included Palashadigudavarti, whereas group B included Diclofenac sodium suppository for administration over Parikartika (acute anal fissures). Gandharva haritaki choorna acts as laxative and helps to relieve constipation and sitz bath was given to both group as conservative management.. Materials and method: Literary aspect of the study was collected from classical Ayurvedic and contemporary text and updated with recent medical journals, previous research work done on same topic. Observation and results: Assessment was done by the parameters such as pain, bleeding and itching as Subjective and healing as Objective Parameter. Results were obtained by statistical analysis. Discussion: In this research work Palash, Goghrita and Beewax as suppository base was used in the form of varti application (advanced anal Suppository) for managing Anal fissure. There is need of ayurvedic suppository easily available in market which will relieves anorectal symptoms instantly, because repeated use of diclofenac sodium have side effect to the body. In the present case series, it proved to be significant in managing Fissure in ano, it reduced pain, itching, bleeding and promoted healing. Conclusion: In the treatment of Parikartika, Palashadigudavarti was more effective than Diclofenac sodium suppository
 Keywords: Parikartika, fissure in ano, Palashadigudavarti, Diclofenac Sodium Suppository.

Comparison of Intramuscular Versus Rectal Diclofenac Sodium in Post Caesarean Pain Relief

Objective: To compare the mean post-operative pain after intramuscular versus rectal Diclofenac Sodium in post-caesarean patients.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Obstetrics & Gynaecology, Benazir Bhutto Hospital, Rawalpindi Pakistan, from May to Nov 2017.
 Methodology: A total of 60 women, aged 18-45years, undergoing elective caesarean section were selected. Patients in Group-A were given, Diclofenac 75mg intramuscularly in the gluteal area every 8 hours, while patients in Group-B received a Diclofenac Sodium suppository every 8 hours post-operatively. All patients were followed for pain post-operatively, and final post-caesarean pain was noted at 24 hours post-operatively using a visual analogue scale.Results: The mean age of patients in the Group-A was 29.27±4.68 years, and in Group-B was 30.57±4.80years. The range of gestational age in the study was from 37 to 41 weeks, with an average age of 39.07±1.26 weeks. Mean post-operative pain in Group-A (Intramuscular Diclofenac Sodium-Group) was 1.13±0.43 minutes, whereas in Group-B (Rectal Diclofenac SodiumGroup), was 2.16±0.83 (p-value = 0.001).
 Conclusion: Mean post-operative pain after using intramuscular Diclofenac sodium is less than Diclofenac Sodium administered rectally in post-operative patients in caesarean sections.

The Wound Dressing Influenced Effectiveness of Cryotherapy After Anterior Cruciate Ligament Reconstruction: Case–Control Study Comparing Gauze Versus Film Dressing

PurposeTo compare the clinical effectiveness of cryotherapy after anterior cruciate ligament reconstruction using 2 different wound dressings, conventional postoperative gauze dressings and polyurethane semipermeable transparent film dressings.MethodsIn total, 60 patients who had undergone arthroscopic anterior cruciate ligament reconstruction with an autogenous patellar tendon were assigned to 2 groups. The surgical wound was covered with 5 sheets of gauze with an elastic bandage (control group) in 30 patients and film dressing was used (film group) in the remaining 30 patients. Silicone drainage catheters were inserted at the intercondylar notch, beside the distal outlet of the tibial tunnel for 2 days. After 1 hour of cooling using the device, the knee was chilled with an ice bag every 2 hours until the next morning. The severity of pain was evaluated by the number of times an analgesic, 50 mg of diclofenac sodium suppositories, had to be administered in the 24 hours after surgery. The amount of drainage during the following 2 days, the range of motion at 21 days, the change of hemoglobin concentration at 1 and 7 days, and C-reactive protein (CRP) at 1 and 7 days were examined.ResultsThe number of patients who used an analgesic was 18 in the control group and 7 in the film group (P = .003). The amount of drainage was 165.2 ± 72.9 mL in the control group and 289.7 ± 77.6 mL in the film group (P < .001). The postoperative CRP value was 0.77 ± 0.65 mg/dL at 1 day in the control group and 0.39 ± 0.42 mg/dL in the film group (P = .009). No statistical difference was seen for hemoglobin concentration at 1 or 7 days, CRP at 7 days or range of motion at 21 days.ConclusionsIn this study, we found that film dressing enhanced the effect of cryotherapy with respect to pain control, wound drainage, and inflammation immediately after surgery compared with traditional gauze dressing with elastic wrap.Level of EvidenceIII, case–control study.

Post Operative Pain Management and Patient Satisfection : Experience at a Tertiary Care Hospital

Background: Pain is an inevitable part of the postoperative experience. Current study was designed to assess the pattern of analgesic use, the adequacy of post operative pain control by documenting pain scores and patient satisfaction by documenting the pain perception score of the postoperative patients 48 hours after surgery.&#x0D; Materials and methods: This was a formative research and includes a mix of descriptive cross-sectional study carried out in the Department of Gynecology and Obstetrics, General Surgery and Orthopedics Surgery of Chattagram Maa-O-Shishu Hospital Medical College (CMOSHMC) during the month of January, 2018 to July, 2019.&#x0D; Results: A total of 180 patients underwent surgery were included in this study. Baseline data were collected both retrospectively and prospectively. Only analgesic used immediately after operation in three departments were Pethidine (100%). Diclofenac sodium suppository were used in appendectomy and cesarean section (50/60, 83%) and (26/60, 43%) respectively. Mostly, Diclofenac Sodium IV (55/60, 91%) was used in lower limb surgery. The maximum pain score were 5.3 (SD=2.3), 5.6 (SD =1.9), and 6.1 (SD =1.3) during coughing in the first 8 hour and minimum pain score 2.4 (SD =1.0), 2.2 (SD = 0.8) and 1.7 (SD=1.3) at rest 48 hours after cesarean section, appendectomy and lower limb surgery respectively. But pain score eventually increased during coughing 48 hours after surgery. After 48 hours of surgery maximum pain perception score 3.9 (SD = 0.9) in lower limb surgery and minimum perception score were 3.5 (SD =1.8) in cesarean section. Majority of the appendectomy patient (76%) satisfied with pain management where as only 43% satisfied in case of cesarean section.&#x0D; Conclusion: This study enabled the researchers to get a precise picture of the current state of POPM in different hospitals, as well as identify particular needs for improving such practices in health care facilities and implementing an educational intervention in order to improve the post operative pain management.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 69-73

Efficacy of gelatin sponge impregnated with ropivacaine on postoperative pain after transforaminal lumbar interbody fusion: a comparative study

BackgroundThe purpose of this study was to investigate the efficacy of gelatin sponge impregnated with ropivacaine on postoperative pain after transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative diseases.MethodsWe retrospectively reviewed patients who underwent TLIF in our department between August 2018 and January 2020. Patients were divided to ropivacaine group and saline group. A ropivacaine group whom received gelatin sponge impregnated with ropivacaine during operation, and a saline group whom were intraoperatively administered by gelatin sponge impregnated with saline. The two groups were compared in reference to postoperative hospital stay, postoperative complications and visual analog scale (VAS) scores. The consumption of postoperative diclofenac sodium suppository use was also recorded. The Oswestry Disability Index (ODI) scores and Japanese Orthopedic Association (JOA) scores were used for functional evaluation at 1 year postoperatively.ResultA total of 127 patients were evaluated in this retrospective study. The mean postoperative hospital stay in the ropivacaine group was significantly lower than saline group. The VAS score was significantly lower in patients receiving gelatin sponge impregnated with ropivacaine as compared with patients in saline group on postoperative day 1, 2, 3 and 4. The number of patients who need the administration of diclofenac sodium suppository and the mean consumption of postoperative diclofenac sodium suppository was significantly lower in the ropivacaine group as compared with saline group.ConclusionThe application of gelatin sponge impregnated with ropivacaine around the nerve root in patients undergoing TLIF can effectively control the postoperative pain and reduce postoperative hospital stay.

Comparative Study of Palashgudavarti and Diclofenac Sodium Suppository in the Management of Acute Fissure in Ano (Parikartika)-An Ayurvedic Management Protocol

Background - Anal Fissure is one of the major causes for pain at anal region. The two primary signs ofthis disease are pain and bleeding, and pain is often unbearable. In males anal fissure typically occursin the midline posterior- 90 %, and 10 % midline anterior. Subsequently, female fissures on the midlineanteriorly are significantly more frequent than posteriorly (60:40). In contemporary sciences Parikartikacan be correlated with Fissure in Ano. Objective- The objective of the prospective study is to find theefficacy of Palashgudavarti &amp; Diclofenac Sodium Suppository in the management of Acute Fissure inano(Parikartika).Material &amp; Method: The present study is designed as a Randomized single blind parallelin which 60 patients will be enrolled. Varti will be applied for local application once a day. Assessment willbe done 0th, 7th day, 14thday, and 28th day. Results: The changes are expected to be observed in subjectiveparameters such as pain bleeding per rectum with itching as well as with objective parameters such asParikartika Healing. Conclusion: The study is expecting the nonsurgical management of fissure in ano withrespect to the impact of Palashgudavarti &amp; Diclofenac Sodium Suppository. The research is expecting to bebaseline and benchmark of the prospective studies in Acute Fissure in ano (Parikartika).

Comparing the Efficacy of Paracetamol, Diclofenac, and Ketorolac on Post-Appendectomy Outcomes in Children and Adolescents

Abstract &#x0D; urgent surgical intervention and appendectomy until now represent standard treatment for uncomplicated cases of appendicitis. Nausea, vomiting and pain after surgery are the most frequent issues facing patients and affecting patient quality of life and responsible for many cases of readmission after surgery. Ketorolac and diclofenac represent the most commonly prescribed non-steroidal anti-inflammatory used in postoperative setting and they cause many side effects as gastrointestinal, kidney and cardiac adverse effect in addition to increased risk of bleeding. Paracetamol is currently among the most frequently prescribed medication worldwide and it can be used safely for all age groups. This study aimed to compare the analgesic efficacy and safety of paracetamol, diclofenac, and ketorolac when used after appendectomy and to assess their efficacy regarding nausea and vomiting in children and adolescents. A randomized, single-blinded, comparative, observational prospective clinical study was carried out on patients diagnosed with acute appendicitis and assigned for emergent appendectomy between October 2018 to May 2019 in Al- Zahraa Teaching Hospital in Al-Najaf province, Iraq.120 patients were randomly distributed into three groups who received diclofenac sodium suppositories (2mg/kg), IV Paracetamol )15mg/ kg every 6 hr.(, and IV Ketorolac )0.5mg/ kg( immediately after surgery. All patients were observed for pain, nausea and vomiting and bleeding. Patients received ketorolac had a high percentage of the decrease in pain score between 30 and 60 min. after surgery, while paracetamol was the next and diclofenac sodium was the last. Regarding nausea and vomiting after surgery, ketorolac had higher percentage of the decrease in nausea, vomiting score during first day after surgery followed by diclofenac and paracetamol respectively. The present study also showed that there is no significant difference between groups regarding bleeding after surgery. It is concluded that ketorolac has higher analgesic efficacy compared with paracetamol and diclofenac with no risk of nausea and vomiting and bleeding when used after appendectomy.&#x0D; Keywords: Postoperative pain, Ketorolac, Diclofenac, Paracetamol, Appendectomy.&#x0D;

Comparative Assessment of the Analgesic Efficacy of Tramadol and Diclofenac Sodium Rectal Suppository in Subjects Undergoing Laproscopic Tubal Ligation

Background: Several drugs such as NSAID s or opiods can be used orally, intravenously or intramuscularly for treatment of post operative pain. The aim of our study was to compare the analgesic efficacy of tramadol and diclofenac sodium suppository and the secondary aim was to monitor and treat the complications if any. Subjects and Methods: Fifty female patients of ASA I and II in the age group of 24-42 posted for laproscopic tubal ligation were enrolled in the study. Verbal analogue scale (0- no pain to 10- worst possible pain) score reading was explained. In the pre operative room all the patients were randomly allocated in two groups by a computer generated list. Post operatively all the hemodynamic parameters and VAS score were recorded at regular intervals of 1, 2, 4, 6, 8, 10,12hrs. Pain was assessed by a staff trained to VAS score assessment and was blinded to the study group. Side effects of nausea and vomiting were noted. Results: Group 2 had high mean age of the study participants compared to group 1 but the comparison was non-significant.(p≤0.05) Only one patient in group A (tramadol) complained of nausea and vomiting. In group A 69% patients needed 1 rescue analgesic at 8 hrs, 11% at 6hrs, 9% at 4hrs and 11% at 10 hrs whereas in group B 64.1% patients needed 1 rescue analgesic at 8hrs, 16.2% at 10 hrs and 19.7 % at12 hrs. &nbsp;Conclusion: From above findings it was concluded that analgesic efficacy of tramadol and diclofenac sodium suppository is comparable. Rectal administration of tramadol reduces the incidence of nausea and vomiting.

Efficacy of continuous local cryotherapy following total hip arthroplasty.

Background: Cryotherapy is rarely reported on the usefulness of cryotherapy applied after total hip arthroplasty (THA), and there are no reports about patient satisfaction against the cryotherapy following THA. The aim of this study was whether cryotherapy can be useful for relieving pain, reducing blood loss, and swelling, and improving patient satisfaction after THA. Methods: Thirty patients who had undergone THA were treated by a controlled cooling device for 72 h following THA (defined as the cryotherapy group). The other 30 patients without cryotherapy were not treated with cryotherapy (defined as the control group). Blood samples (creatine kinase, and C-reactive protein), estimated blood loss, visual analog scale (VAS) of pain score, total doses of diclofenac sodium suppository used for pain relief, thigh swelling, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and adverse outcomes were compared between two groups. Results: Thigh circumference, measured on only day 4 postoperatively, was significantly lower in the cryotherapy than in the control group. Furthermore, patient satisfaction on postoperative days 4 and 7 was significantly higher in the cryotherapy than in the control group. There were no significant differences in other outcomes between groups. Conclusions: These results support the potential benefit of cryotherapy for the reduction of swelling, and patient satisfaction during postoperative recovery of patients undergoing THA, even in the presence of periarticular injection and tranexamic acid administration for the prevention of postoperative pain and bleeding. Postoperative cryotherapy is a potentially simple, noninvasive, and relatively inexpensive option for post-THA management.

Comparison of standard percutaneous nephrolithotomy and tubeless percutaneous nephrolithotomy

Objective Using Wisconsin Stone Quality of Life questionnaire(WISQOL) to compare standard percutaneous nephrolithotomy(PCNL) and tubeless PCNL. Methods From January 2017 to June 2017, patients who met the criteria (no urinary tract infection, stones between 1-3 cm, hydronephrosis larger than 3cm, renal cortex thickness >2 cm and without serious heart, lung, liver and kidney dysfunction and coagulation dysfunction) and underwent PCNL were prospectively enrolled and randomized into 2 groups, standard PCNL group and tubeless PCNL group. Diclofenac sodium suppositories were used to relieve pain in all patients with obvious pain. The quality of life of these patients were estimated and compared by using WISQOL. Safety and efficacy were also estimated. Result At the end of the study, a total of 50 patients were included in the analysis. There were 24 patients in the standard PCNL group and 26 patients in the tubeless PCNL group. There were 9 male patients in the standard PCNL group and 17 male patients in the tubeless PCNL group. There was no significant difference in gender between the two groups. The differences between the standard PCNL group and tubeless PCNL group in mean age(yrs.)[(53.21±13.35)vs.(51.1±11.5), P=0.55], stone diameter(mm)[(18.46±5.58)vs.(18.75±5.39), P=0.85], stone-free rate(23/24 vs. 24/26, P=0.60), mean hemoglobin decline(g/L)[(11.87±9.20)vs. (10.43±8.49), P=0.56] were not significant. Mean dosage of acesodyne(pcs) in tubeless PCNL group (4.07±1.49)was significantly less than that in standard PCNL group(7.54±2.23). There were no patient need transfusion or postoperative fever management. The influence of perioperative quality of life of patients treated with tubeless PCNL is significantly better than those treated with standard PCNL in 16 items which includ energy, sleep, work and family, physical symptoms, concerns related to intimacy and travel, and general emotional well-being. Conclusion Tubeless PCNL can improve patients’ quality of life compared with standard PCNL. Key words: Percutaneous nephrolithotomy; Quality of life; Renal stone; Tubeless

Clinical application of diclofenac sodium in the treatment of gynecological hysteroscopy

Objective To investigate the clinical significance of scheduled diclofenac sodium in gynecological hysteroscopic surgery. Methods A total of 125 patients undergoing hysteroscopic surgery were divided into observation group(64 cases) and control group(61 cases) according to the operation date.The observation group received diclofenac sodium(50mg) 30min before operation and after operation.The control group was anesthetized with propofol 2mg·kg-1·h-1.The pain at 1h and 2h postoperatively, the incidence of adverse reactions within 12h after operation, the time from operation to bed ambulation, anesthetic cost and comfort of patients were compared between the two groups. Results The pain scores of VAS in the observation group at 1h and 2h postoperatively were (3.23±1.75)points and (1.84±1.36)points, respectively, which were significantly lower than those in the control group[(5.07±1.73)points and (2.75±1.60)points, t=-5.875, -3.435, all P<0.05]. The incidence of nausea and vomiting in the observation group within 12h after operation was less than that in the control group(5 cases vs.27 cases)(χ2=12.175, P<0.05). The time spent on ambulation of the observation group[(11.17±2.18)min]was significantly shorter than that of the control group[(17.84±3.42)min](t=-12.933, P<0.05). The anesthetic cost of the observation group was significantly lower than that of the control group (1.24 CNY vs.71.30 CNY, t=18.130, P<0.05). Conclusion The diclofenac sodium plan anal preoperative analgesic effect in patients undergoing gynecological hysteroscopic surgery is better, so that out of bed activities ahead of time, can reduce the anesthesia costs, gynecological hysteroscopy can be used as the preferred method of anesthesia. Key words: Administration, rectal; Hysteroscopy; Anesthesia; Diclofenac sodium suppository

Clinical Outcomes After Posterior Lumbar Interbody Fusion: Comparison of Cortical Bone Trajectory and Conventional Pedicle Screw Insertion.

This study is a retrospective cohort study using prospectively collected data. To compare the effectiveness of posterior lumbar interbody fusion (PLIF) using the cortical bone trajectory (CBT) and conventional pedicle screw (PS) techniques. There are few published studies to date comparing PLIF using CBT technique with PLIF using the conventional PS technique. We studied 119 consecutive patients who underwent single-level PLIF between 2010 and 2014 with a minimum 12-month follow-up. Forty-two patients underwent CBT-PLIF (the CBT group) and 77 underwent conventional PS-PLIF (the PS group). Clinical outcomes were assessed by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and visual analog scale (VAS). To assess perioperative pain, a 6-point Numeric Rating Scale score and the total amount of diclofenac sodium suppositories used were recorded. The operative time and blood loss were recorded. Muscle damage was evaluated by serum creatine kinase concentrations. Fusion status was evaluated using 3-dimensional computed tomography 12 months postoperatively. We used inverse probability of treatment weighting based on the propensity score to reduce confounding factors. There were no significant between-group differences in operative time or fusion rates, whereas the CBT group experienced significantly less blood loss, lower postoperative creatine kinase levels, less diclofenac sodium suppositories, and lower Numeric Rating Scale scores than the PS group did. The change in the JOABPEQ subdomain score for social life function 1 month postoperatively was the only significantly different factor among the JOABPEQ and VAS scores. Both procedures were comparable in terms of clinical outcomes and fusion rates, but CBT-PLIF provided the additional benefits of less blood loss, less intraoperative muscle damage, less perioperative pain, and earlier recovery to normal activities.

Usage of Multilevel Paravertebral Block as the Main Anesthesia for Mini-Invasive PCNL: Retrospective Review of 45 Cases with Large Stones

Introduction: To evaluate the efficiency and safety of the paravertebral block (PVB) as the single main anesthesia for unilateral mini-invasive percutaneous nephrolithotomy (PCNL). Materials and Methods: Forty-five American Society of Anesthesiologists grade I/II/III patients with large upper urinary tract stones were included in our retrospective study. All patients received multilevel PVB from T10 to L1 with 10 mL of 0.5% ropivacaine for each segment. After the block was confirmed, unilateral mini-invasive PCNL was performed. Intraoperative and postoperative pain management and associated adverse events were observed to investigate the feasibility of PVB in mini-invasive PCNL as the main anesthesia. Results: Successful blocking was confirmed 20 min after paravertebral injections. The mean operation time was 59 min. None of the patients experienced severe pain or hemodynamic dysfunction. Stone-free rate was 93.1% and no blood transfusion was required. The mean time to first analgesic requirement was 160 min, and the mean consumption of diclofenac sodium suppositories was 150 mg. All patients contained normal muscle strength on the contralateral side. Patients could recover ambulation within 1 h after the operation. Conclusions: Multilevel PVB was proved to be suitable as the main anesthesia for unilateral mini-invasive PCNL, providing feasible pain relief and quick postoperative recovery.

Improvements of post caesarean section pain management following the introduction of a new pain management protocol

Objective To evaluate improvements in post-caesarean section (CS) pain management in University Obstetrics Unit, Ragama, Sri Lanka following the introduction of a protocol for post-CS pain management. Methods A complete audit cycle was conducted in University Obstetrics Unit, Ragama, Sri Lanka. Initially a prospective audit was conducted among 126 consecutive CS during July and August, 2016. Basic demographic data and details regarding post-CS analgesia during the first 24 hours were collected. Re-auditing was done four months after the introduction of the protocol. In the re-auditing, 150 post-CS mother were conveniently selected over a period of three months and a coloured visual analogue scale (VAS) was used to assess the level of pain in the re-audit. Results There were no statistically significant difference between demographic details before and after the protocol. Before introduction of the protocol, use of diclofenac sodium rectal suppositories were the commonest analgesic type (42.9%) used. Only 6 (4.8%) out of 126 patients had properly documented pain management plan in the operative notes. None of the analgesics were prescribed for 6 (4.8%) patients. Out of total 126, only 6 (4.8%) subjects had a proper drug chart maintenance with regular analgesics. Forty two (33.3%) women were was not on any analgesics within the first 24 hours. After introduction of the protocol, regular analgesic dosing were given to 140 (93.3%) women with satisfactory drug chart maintenance in 140 (93.3%) cases. Out of 150, 140 (93.3%) patients received analgesia with at least a single method. Mean VAS score was 3.5 (SD 2.0) after first 24 hours. Diclofenac sodium suppository (86.7%) is the commenst first line medication. There was statistically significant difference (P Conclusion There was a significant improvement in post-CS pain management after introduction of a new post-CS pain management protocol.

Syndrome of chronic task pain in patients with calculus prostatitis: search for optimal therapy

The objective: to determine the efficacy of the combination of the method of extracorporeal shock wave therapy (ESWT) and non-steroidal anti-inflammatory drugs (NSAIDs) in the correction of pain in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in patients with CP of the IIIb category. Patients and methods. Extracorporeal shock wave therapy in 57 men (mean age 38.2 ± 2.1 years) with symptoms of CPPS on the basis of chronic calculous prostatitis (CP category IIIb) was performed in the Department of Sexopathology and Andrology of the Institute of Urology of the NASU of Ukraine. All patients were divided into three groups, in I (n=27) – patients received suppositories Dicloberl 100 mg once a day for 20 days, in II (n=19) – suppositories Dicloberl 100 mg once a day 20 days and Nimesil 100 mg inside the morning after a meal – 5 days; In ІІІ (n=11) tocopherol acetate 400 mg once a day for 30 days inside after eating. The duration of the disease was from 8 months to 5,2 years. All patients underwent a standard urologic examination and pain assessment on the NIH-CPSI scale. The parameters given above were monitored 3 times during the study: before treatment, 1 and 3 months after treatment. At the last visit, the subjective assessment of the efficacy and tolerability of the drug was recorded by patients and treating physicians. It was found that the use of diclofenac sodium in suppositories, in persons with CP / CTPS receiving ESWT, contributed to a significant reduction in pain on the scale of NIH-CPSI for a 30-day period of treatment at 48,4±1,8% (p<0,05) and demonstrated high compliance (according to the patient –77,7%, according to the doctor – 81,4%). Results. It was also found that the use of a combination of diclofenac sodium suppositories with the oral form of nimesulide, in these cases, reduced the NIH-CPSI values by 55,7±2,1% of the initial, and the compliance was 84,1% according to the patient, – 89,3% (р<0,05). Conclusion. Carrying out extracorporeal shock wave therapy in persons with calculous prostatitis and chronic pelvic pain syndrome is an effective measure of pain relief, and NSAIDs (diclofenac sodium and nimesulide) significantly improve the results of treatment.

Clinical observation on relieving mixed hemorrhoids postoperative pain by ear buried beans associate with Diclofenac Sodium Suppositories

Objective To observe the effect of ear buried beans associate with Diclofenac Sodium Suppositories on relieving mixed hemorrhoids postoperative pain. Methods A total of 60 cases of mixed hemorrhoids patients were randomly divided into the treatment group and the control group, 30 cases of each group.The control group was given Diclofenac Sodium Suppositories.The treatment group was given ear buried beans on the basis of the control group.Postoperative pain intensity and the times of patients with Diclofenac Sodium Suppositories was observed after 6 hours, 24 hours and 48 hours between the two groups. Results The pain intensity of the treatment group was obviously lower than that of the control group, and the difference was statistically significant(P<0.05). The number of topical analgesics were significantly reduced.The difference between the two groups was statistically significant(P<0.05). Conclusions Ear buried beans associate with Diclofenac Sodium Suppositories can relieve mixed hemorrhoids postoperative pain.It has an exact effect and has no adverse reaction.It is worthy of clinical reference. Key words: Ear buried beans; Diclofenac Sodium Suppositories; Mixed hemorrhoids; Postoperative pain

Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries

Background: Post operative pain is a major concern in children particularly in developing countries were opioids are not freely available. Use of opioids is associated with side effects increasing patient discomfort and delaying patient discharge from hospital. We conducted a study comparing the use of different doses of rectal paracetamol with rectal diclofenac when used as pre-emptive analgesics on postoperative pain and recovery in paediatric patients considering the relative risk of diclofenac to increase bleeding in surgeries like tonsillectomy, cleft lip and cleft palate. Methods: Study groups included 20 patients in each. Group P40 receiving 40 mg/kg rectal paracetamol, Group P20 receiving 20 mg/kg rectal paracetamol, Group D receiving rectal diclofenac 1 mg/kg. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale) time to first need of analgesia and total dose of analgesia was noted. The rates of recovery were evaluated by using “Modified Steward Coma Scale”at 5 and 10 minutes after extubation. Results: Time of first demand of analgesic was delayed in Group-P40 as compared to Group-D and Group-P20 and difference was statically significant. TPPPS of the three studied groups varied significantly at different time intervals in favour of Group-P40. Total duration of analgesia in Group- P40 was (646±9.94) min Group- D (501±10.63) min and in Group-P20 (294±23.17) min Total analgesic requirement was also low in Group P40 and the difference between groups was significant. Conclusion: Pre-emptive high dose rectal paracetamol appears to be more effective than rectal diclofenac sodium suppository for postoperative analgesia in children without additional risk of bleeding in surgeries like tonsillectomy and cleft lip and cleft palate repair. Hence, high dose rectal paracetamol can be used as an alternative to diclofenac sodium due to higher risks of bleeding with diclofenac sodium in surgeries with increased risk of bleeding.

Application of diclofenac sodium suppository anal preemptive analgesia combined with lidocaine hydrochloride in circumcision

Objectives To investigate analgesia effect and curative effect of diclofenac sodium suppository anal ahead in circumcision resection. Methods 200 patients with redundant prepuce were randomly divided into control group and the experimental group, patients in control group was given with 1% lidocaine 10mL for penile block anesthesia, patients in experimental group were given diclofenac sodium suppository anal before the surgery, and then given 1% hydrochloric acid lidocaine 10mL for penile block anesthesia. Efficacy of diclofenac sodium suppository anal super analgesia was evaluated. Results Compared with the control group, the pain of the patients in the experimental group was significantly lower than that of the 1~3h after anesthesia, and the difference was statistically significant (P<0.05). Conclusions Diclofenac sodium suppository anal can effectively reduce pain of circumcision anesthesia and postoperation. It is recommended that the diclofenac sodium suppository is used in clinical operation for reducing the patient's pain. Key words: Circumcision, Male; Lidocaine; Analgesia

Effects of music therapy on pain, anxiety, and vital signs in patients after thoracic surgery

ObjectiveTo examine the effectiveness of music listening on pain, anxiety, and vital signs among patients after thoracic surgery in China. Design and settingA randomized controlled clinical trial was conducted in the thoracic surgery department of two tertiary hospitals in Wuhan, China. 112 patients were recruited and randomly assigned to either experimental (n=56) or control (n=56) group respectively. InterventionThe experimental group received standard care and a 30-min soft music intervention for 3 days, while the control group received only standard care. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate), patient controlled analgesia, and diclofenac sodium suppository use. ResultsThe experimental group showed statistically significant decrease in pain, anxiety, systolic blood pressure and heart rate over time compared to the control group, but no significant difference were identified in diastolic blood pressure, respiratory rate, patient controlled analgesia and diclofenac sodium suppository use. ConclusionThe findings provide further evidence to support the practice of music therapy to reduce postoperative pain and anxiety, and lower systolic blood pressure and heart rate in patients after thoracic surgery in China.