Injection Of Diclofenac Research Articles

Intradermal sterile water injection versus diclofenac sodium in acute renal colic pain: A randomized controlled trial.

We aimed to evaluate the efficacy of intracutaneous sterile water injection (ISWI) to relieve the pain of acute renal colic compared with diclofenac and placebo. The study included 150 patients presented to the Emergency Department with renal colic randomized into 3 groups: control group received intracutaneous injections of 0.5cm3 isotonic saline in the flank, group A received intracutaneous injections of 0.5cm3 ISWI in the flank, and group B received an intramuscular injection of 75mg Diclofenac in the gluteal region. The severity of the pain was assessed by a visual analogue scale system at baseline and 30, 45min, and 60min after injections. Subjects with inadequate pain relief at 1h received rescue analgesia. The mean baseline pain score was 9.6±0.61 in the ISWI group, 9.72±0.64 in the diclofenac group and 9.26±0.89 in the control group. The mean pain score at 30min of the control group was reduced to 6.9±1.56. This mean at 30min after ISWI and diclofenac injections were reduced to 1.98±1.41 and 1.88±1.19 respectively. The mean of pain sore of the ISWI and diclofenac group at 45 and 60min was constant. Rescue analgesics at 1h were required by 47 patients receiving the saline injection and by 4 patients and by 7 patients receiving ISWI and diclofenac injection respectively. ISWI and diclofenac were equally effective for the pain relief of acute renal colic.

Comparing the Efficacy of Postoperative Diclofenac Suppository with Intramuscular Diclofenac in Children under going Inguinal Hernia Surgery

Objective: To compare the analgesic effect of postoperative Diclofenac suppository with intramuscular Diclofenac in children undergoing inguinal hernia surgery. Methodology: This study was held in Paeds Surgery Department, Nishtar Hospital Multan, Bahawal Victoria hospital Bahawalpur. from August 2018 to March 2019. Total no. of 160 patients were divided into two groups, one receiving diclofenac suppository group DS and the other which was group DI received intramuscular diclofenac injection. Numerical variables like age and weight were analyzed statistically by taking their mean and standard deviation while the outcome variable i.e. severity of pain was assessed through facial expressions as no pain, mild, moderate and severe pain in frequency percentage at 0, 2 and 4 hours interval. Results: Total 160 patients were divided into 2 groups equally, 80 in each (DS & DI). There was no significant difference in the efficacy of diclofenac suppository and diclofenac intramuscular when calculated at 0, 2 and 4 hours interval. When Chi-Square was applied to determine the association, it was observed that pain severity was significantly associated with age. But the association of pain severity with weight and with time intervals in two groups was not statistically significant. Conclusion: From this study we conclude that there is no significant difference between the postoperative analgesic effect of either suppository or intramuscular diclofenac but suppository route has an advantage over intramuscular in that it is easier and safer, less prone to injury, easy to administer and has longer duration of action, especially preferable in pediatric patients. Keywords: Children, diclofenac Sodium, inguinal Hernia, intramuscular, suppository DOI: 10.7176/JMPB/65-05 Publication date: April 30 th 2020

OBSERVING DRUG UTILIZATION TRENDS OF ANALGESICS IN INDOOR SURGICAL PATIENTS IN TERTIARY CARE TEACHING HOSPITAL

Objectives: The objectives of the study were to evaluate and compare the utilization pattern of analgesic use in pre-operative, intraoperative, and post-operative wards of different surgical specialties.
 Methods: It was a prospective, cross-sectional, and observational study done for a period of 1 year and the data were obtained from case sheets of 386 patients admitted in surgical wards of the. Data were analyzed according to demography, type of surgery, and the WHO prescribing indicators. The percentage of analgesic prescribed from an essential medicine list or National list of essential medicine (NLEM), common analgesics, and fixed dose combinations (FDC) used in surgery, gynecology, ENT, and orthopedic wards in preoperatively, intraoperatively, and postoperatively, was assessed and the amounts of drugs consumed were converted into the number of daily defined dose (DDD) as per the 2010 version of ATC/DDD index.
 Results and Discussion: The female to male ratio of 1.21 and most of patients were in the category of middle-aged adults (49%). On the evaluation of WHO prescribing parameters, it was seen the average number of analgesics prescribed per prescription was 1.26, percentage of injectable analgesics and analgesics prescribed from NLEM were 81.09% and 90.64%, respectively. Perioperatively, injection diclofenac sodium was the most commonly used analgesic and its DDD was 460. The most common FDC used perioperatively was aceclofenac 325mg+serratiopeptidase 15 mg (5.04%) and Drug Controller General of India and the WHO approved FDCs were 80.28% and 75.53%, respectively.
 Conclusion: It is necessary to determine the prevalence and severity of post-surgical pain and implementation of standardized pain evaluation and treatment protocols which improve the post-operative patient care in the hospital setting.

Local Effect of Intramuscular Injection of Meloxicam and Diclofenac: An Experimental, Comparative and Histological Study

Local Effect of Intramuscular Injection of Meloxicam and Diclofenac: An Experimental, Comparative and Histological Study

Postoperative Analgesic Effect of Bupivacaine alone and with Dexmedetomidine in Wound Instillation for Lumbar Laminectomy: A Randomized Control Trial.

Background:Dexmedetomidine has been used as an effective adjuvant to local anesthetics in peripheral nerve blocks and at the incision site.Aims:We compared the postoperative analgesic effect of bupivacaine alone and in addition of dexmedetomidine to bupivacaine in wound instillation during lumbar laminectomy.Setting and Design:This was a prospective, double-blind, randomized control trial.Subjects and Methods:Sixty adults of the American Society of Anesthesiologists Grade I–II scheduled for elective lumbar laminectomy under general anesthesia were randomly allocated into two groups. Group B (control group) patients received wound instillation with 20 mL of 0.25% bupivacaine at the end of surgery and Group D patients received 2 μg.kg−1 dexmedetomidine diluted in 20 mL 0.25% bupivacaine as instillation over the incision site. If the NRS exceeded “4” at any point of time, rescue analgesia with injection diclofenac 75 mg deep intramuscular was administered. Postoperative pain score, duration of analgesia, total rescue analgesic required in the first 24 h, and side effects were compared between the groups.Results:Demographic data were comparable in both the groups. Duration of analgesia (19.93 ± 3.2 in Group D vs. 12.13 ± 1.8 in Group B) was significantly more in Group D, number of analgesic demands were less in group D as compared to Group B, and total rescue analgesic required (62.51 ± 39.13 vs. 95.68 ± 33.5) was significantly less in Group D as compared to Group B.Conclusions:We conclude that dexmedetomidine 2 μg.kg−1 is an effective adjuvant to bupivacaine for wound instillation in terms of quality and duration of postoperative analgesia following lumbar laminectomy.

Comparison between intravenous injectable diclofenac and per rectal diclofenac suppository as analgesics in operated per anal and perianal benign pathologies

Background: Per anal and perianal surgeries are one of the bread and butter surgeries in a surgeons life, and satisfaction of patient matters a lot. Early miraculous recovery has always been patient’s expectations hence we decided to study standard IV method of diclofenac as analgesic with diclofenac suppository and compared their effects on patients with the help of pain scale of 0 to 10.Methods: 200 common per anal surgeries were considered in the study, and were divided in two groups group A post operatively IV diclofenac was given 12 hourly and in group B cases diclofenac suppository 100 mg was started daily twice and the pain score was noted for a week.Results: Diclofenac suppositories resulted in early pain relief and thus early discharges of these patients. The pain score had decreased to a larger extent by day 3 and was almost negligible by day 5 and a few cases to day 7. The hospital stay reduced as patient could manage suppository at home by themselves. IV site complications like thrombophlebitis leading to pain and fever could be easily avoided.Conclusions: Thus diclofenac suppositories proved to be an effective way to give a pain free satisfaction compared to intravenous painful analgesics, thus decreased their hospital stay and also it was a patient friendly.

Residues of Diclofenac Sodium in Rabbit Tissues

The current study aimed to determine residues of diclofenac in different rabbit tissues (liver, muscles, kidneys, spleen, heart , lungs) and serum following intramuscular injection of diclofenac. Tissues were extracted and diclofenac residues were assayed using high-performance liquid chromatography (HPLC). A total of twenty healthy male New Zealand White rabbits were classified into two groups; the first group (n=15) was injected with diclofenac for four successive days at dose 1.5mg/kg twice daily , while the second group (n=5) untreated (control). and then samples were collected on the 1st day , 3rd day, 5thday and 7th day. Diclofenac remained within the detectable limit till the 3rd day in most tested tissues, while in muscle and kidney remained till the 5th day following the last dose of drug administration . Therefore, It can be concluded that rabbit muscles and kidney could be consumed safely after the 5th day post treatment with that dose, while, rabbit liver could be consumed safely after the 3rd day post treatment with that dose without any hazards on consumers according to established recommended MRL.

Comparison of Safety, Efficacy, Patient Compliance and Cost-Effectiveness of Transdermal, Oral and Intramuscular Diclofenac for Pain Control Following Oral Surgical Procedures.

To evaluate transdermal diclofenac in terms of analgesic efficacy, safety, compliance and cost-effectiveness and to compare it with oral tablets and intramuscular (IM) injections following surgical removal of impacted mandibular third molars. A prospective, single-centre, multi-arm parallel, randomized study on subjects undergoing extraction of impacted mandibular third molars was conducted between January 2016 and December 2017. The study included 90 participants, 30 in each group. Participants received the standard once daily (OD) dosages of diclofenac in each group for three post-operative days and were advised to consume paracetamol 500mg as rescue analgesics if the pain was not alleviated. Outcome measures such as demographics, duration of surgery, post-operative pain, the number of rescue analgesics taken, adverse drug reactions experienced and overall global assessment for three post-operative days were recorded by the participants on a questionnaire. Transdermal and oral forms achieved similar analgesia on all 3days. Injectable diclofenac had significantly better pain control on the second and third post-operative days compared to tablets and on the third day compared to transdermal diclofenac. A higher number of rescue analgesics was consumed in oral group on day 1. Gastritis and vomiting were seen in 36.66% and 10% cases, respectively, in oral group. 100% of those in IM group had pain on injection. 6.6% complained of dry skin due to patch, while 3.33% had rash and pruritus. Transdermal group had better overall global assessment by patients with 16.67%, 46.67% and 20% participants reporting excellent, very good and good pain control, respectively. The cost in INR was maximum for the transdermal group. Transdermal diclofenac is an excellent alternative to oral and parenteral routes of drug administration in oral surgical procedures with adequate analgesic efficacy, good compliance and fewer side effects.

Intramuscular versus oral diclofenac for acute pain in adults with acute musculoskeletal injuries presenting to the ED setting: a prospective, double-blind, double-dummy, randomised controlled trial

ObjectiveThe current study aimed to ascertain differences in early postmedication pain reduction in participants presenting with acute musculoskeletal injuries (MSI) to the ED receiving intramuscular (IM) versus per oral (PO)...

Transdermal Buprenorphine versus Intramuscular Diclofenac for Postoperative Analgesia following Upper Abdominal Surgery under General Anesthesia: A Randomized Controlled Trial

Aim: To compare the post-operative analgesic effect of of buprenorphine 20 μg/h patch with diclofenac 75 mg intramuscular injection following upper abdominal surgery under general anesthesia (GA). Materials and Methods: An open-label, randomized, controlled trial (CTRI/2018/03/012694) was conducted with adult subjects of either sex, undergoing planned major upper abdominal surgery under GA. Preoperative medication regimen and anesthesia protocol were uniform for all patients. Buprenorphine patch was applied to a hairless area of the chest or upper arm 12 h before surgery. Diclofenac 75 mg was injected into the deltoid muscle just after extubation. Postoperatively, vital signs were monitored along with Ramsay sedation scale (RSS) score. Postoperative analgesia was assessed using visual analog scale (VAS) scoring, at 4-h interval for the first 12 h and then 12-hourly for the next 2 days. Tramadol 2 mg/kg intravenous was permitted as a rescue analgesic. Results: Each arm had 35 patients without dropouts. The groups remained comparable in VAS pain score at all time points. However, with buprenorphine, although VAS score declined over time, the reduction attained statistical significance in comparison to the baseline (4 h) VAS score only at 72 h. In contrast, with diclofenac, VAS score achieved statistically significant reduction from 8 h onward and this was maintained throughout. In the buprenorphine arm, 21 patients (60.00%) required rescue analgesia in contrast to 10 (28.57%) on diclofenac (P = 0.016). Vital parameters and RSS remained essentially unchanged in both groups. Conclusion: Although the primary outcome measure was comparable between the groups, the pattern of rescue analgesia use suggests that postoperative analgesia experience with buprenorphine patch was less satisfactory than diclofenac injection in this study.

Evaluation of Prophylactic Effect of Intramuscular Diclofenac Sodium for Prevention of Succinylcholine-Induced Myalgia

Background: Succinylcholine a depolarizing muscle relaxant with rapid onset, predictable course and short duration of action is associated with myalgia.
 Objectives: To assess the efficacy of intramuscular injection of diclofenac sodium in preventing succinylcholine-induced myalgia.
 Materials and Methods: Eighty healthy adults scheduled for elective surgery under general anesthesia were enrolledin a double-blind study and randomly allocated into two groups of forty patients. Patients in Group I (diclofenacgroup) were pretreated with inj. diclofenac 75 mg deep intramuscularly into gluteal region one hour prior to induction of anesthesia, while patients in Group II (saline group) received an equivalent volume of saline inj. in same site. Anesthesia was induced in both groups with fentanyl 1.5 mcg/kg, propofol 2.0 mg/kg and succinylcholine1.5 mg/kg. Postoperative myalgia was assessed 24 hours after induction and graded as nil, mild, moderate, or severe.
 Results:The demographic data for both groups were comparable (p > 0.05). Postoperative myalgia was recorded at 24 hours after induction in diclofenac group with twelve (30%) patients and 24 (60%) patients in normal saline (control) group respectively (p < 0.05). Conclusion: Prophylactic use of intramuscular injection of diclofenac is effective in the prevention of postoperative myalgia
 KYAMC Journal Vol. 10, No.-1, April 2019, Page 35-38

A comparative evaluation of analgesic effects of using intravenous paracetamol versus intravenous diclofenac post-operatively in laparoscopic cholecystectomy patients in SMIH, department of surgery, Dehradun

Background: Post-operative adequate analgesia plays an important role in early mobilization, short hospital stay and patient satisfaction in laparoscopic cholecystectomy. The use of opioids for providing postoperative analgesia has been marked by side effects like vomiting, nausea, sedation, respiratory distress, etc. hence, alternate drugs like paracetamol (PCM) and diclofenac are commonly used. In this study, we have compared the analgesic efficacy and any associated side effects of the two commonly used non-opioid NSAIDS namely paracetamol and diclofenac.Methods: We compared 50 patients undergoing laparoscopic cholecystectomy in ASA I and II. They were randomly divided into two groups, Group A and Group B. Group A was administered intravenous PCM and Group B was administered injection diclofenac sodium. Postoperatively, these patients were assessed for pain, blood pressure, respiratory rate, and presence of any side effects like nausea, vomiting or any respiratory discomfort.Results: The mean DBP, MAP and VAS score was significantly (p-value <0.05) in Group A as compared to Group B patients at 4, 8, 12 and 24 hours postoperatively. There was no statistically significant difference in mean SBP and O2 saturation in both groups. The mean pulse rate was lower in Group A as compared to Group B at 8, 12 and 24 hours.Conclusions: This study concluded that postoperative PCM infusion provided better analgesia for a prolonged period of time with minimal side effects.

Gum Acacia mitigates diclofenac nephrotoxicity by targeting monocyte chemoattractant protein-1, complement receptor-1 and pro-apoptotic pathways

Treatment of many inflammatory diseases involves a chronic use of NSAIDs in large doses increasing acute kidney injury risk. This study was designed to evaluate a potential renoprotective effect of Gum Acacia (GA) on diclofenac (DICF) induced nephrotoxicity. Six groups of rats were used: normal group; control group (deprived from water during week 13), DICF group (deprived from water during week 13 and injected DICF i.p. 15 mg/kg/12 h at days 4 through 6 of water deprivation days, GA groups (1, 2 or 3 g/kg/day in drinking water) for 12 weeks followed by water deprivation and DICF injection as described. Kidney function, oxidative stress and anti-oxidant biomarkers were measured. Interleukin-1β, IL-10, TNF-α, complement receptor (CR)-1, monocyte chemoattractant protein (MCP)-1 and caspase-3 were assessed. Kidney sections were scored for fibrosis, tubular injury and inflammatory cells. An elevation in renal biomarkers, inflammatory cytokines, malondialdehyde and apoptotic markers was observed after DICF injection (p < 0.001). Gum Acacia (mostly 3 g/kg) markedly reduced fibrosis, tubular injury, IL-1β, TNF-α, caspase-3 and MCP-1 levels (p < 0.01). It increased IL-10, anti-oxidant capacity, CR-1 level in the kidney (p < 0.001). Protective effect may be mediated by antioxidant, anti-inflammatory and anti-apoptotic mechanisms besides interfering with monocytes and complement mediated tissue damage pathways.

Effect of Age and Gender on Incidence of Post Spinal Headache

Background: Post spinal headache is a common complication after spinal anaesthesia, lumbar puncture and myelography. The aim of study is to calculate the incidence of post dural puncture headache in non-obstetric patients coming to the GMERS Medical College and civil hospital, sola, Ahmedabad. Subjects and Methods: A prospective observational study was conducted on 150 patients of ASA grade I and II admitted in the department of general surgery, orthopedic and gynecology under spinal anaesthesia. All patients were interviewed after 12 hours, 24 hours, 36 hour, 48 hours, 60 hours and 72 hours as regard to headache, its severity, location character, duration, associated symptoms like nausea, vomiting, auditory and ocular symptoms. PDPH was treated initially conservatively with bed rest, hydration and analgesic (injection diclofenac 75 mg). If the PDPH persisted longer than 24 hour with same severity, and epidural blood patch was considered before discharged from hospital. Results & Conclusion: The overall incidence of PDPH in Civil Hospital, Sola, and Ahmedabad was 8.06%. The incidence of PDPH in young patients was 12.12% and in old patients were 3.44%. The incidence of PDPH in female was 12.5% and in male was 4.08%. Thus female significantly have more risk of developing PDPH. The onset o PDPH after dural puncture among the patients who develop PDPH occurred within 24 hours in 33.3%, within 30 hours in 40% and within 36 hours in 26.6% of patients. PDPH was most commonly located in occipital region in 60% of patients. Severity of PDPH was mild to moderate. In 73.3% of patients the maximum severity was grade II. Nausea and vomiting was associated with severe PDPH. No patients develop any other associated symptoms.

A novel triple oral regime provides effective analgesia during extracorporeal shockwave lithotripsy for renal stones.

Context:Analgesia during extracorporeal shockwave lithotripsy for renal stone is an essential component. It not only makes the procedure comfortable but also increases the stone-free rate.Aims:The aim of this study was to evaluate the efficacy of triple oral analgesic agents on stone fragmentation and pain relief in comparison to injectable analgesic agents.Settings and Design:This prospective randomized study included 68 patients of renal calculi of size 5–15 mm.Subjects and Methods:Group A had 32 patients, who received injection pentazocine and injection diclofenac, 45 min before the procedure. Group B consisted of 28 patients, who received a combination of oral acetaminophen, 325 mg, oral diclofenac 50 mg, and oral tramadol 37.5 mg, 45 min prior. Procedural findings, pain score visual analog scale (VAS), fragmentation rate, and outcome were recorded.Statistical Analysis Used:Independent t-test and Pearson's correlation test.Results:A total of 60 patients were analyzed. The mean age was 40.2 ± 11.8 years. Both groups were comparable in body mass index, stone size, number, and density. Group A required more shocks than Group B (4274 vs. 3693, P = 0.043). A lower energy level of shocks (kV) was tolerated in Group A (2.5 vs. 3.2, P = 0.002). Group A required more sittings than Group B (2.3 vs. 1.9, P = 0.037). VAS score was significantly less in Group B (2.9 vs. 4.9, P = 0.0001). The overall fragmentation rate was similar among groups (81.2% vs. 89.3%); hence, the successful outcome was (59.4% vs. 75.0%, P = 0.274). The occurrence of adverse events was also equivalent in both groups (P = 0.199).Conclusions:Triple oral regime provides better analgesic effect and quicker stone-free rate than injectable agents but with similar final outcome.

General anesthesia versus spinal anesthesia in laparoscopic cholecystectomy: safety, feasibility, and affordability in rural hospital in India

General anesthesia (GA) is the choice for laparoscopic cholecystectomy (LC). Spinal anesthesia (SA) is usually preferred in patients where GA is contraindicated. In this study, SA was used in 67 patients in whom LC was planned (study group). LC has been conventionally done under GA. Regional anesthesia is usually preferred in patients where GA is contraindicated. SA was used in 67 patients for LC (study group). Moreover, 50 patients were given GA as a control group. There was no modification in the technique, and the intra-abdominal pressure was kept at 8–10 mmHg. Sedation was given if required, and conversation to GA was done in patients not responding to sedation or with failure of SA. Of 67 patients, two patients required conversation to GA. Hypotension requiring support was recorded in 14 (20.89%) patients and 16 (23.88%) experienced neck or shoulder pain or both. Postoperatively, two (2.9%) patients had vomiting as compared 17 (34%) patients who were administered GA. Injectable diclofenac was required in 25 (37.3%) patients for abdominal pain within 2 h postoperatively and oral analgesic for 53 (79.10%) patients within the first 24 h in SA group. However, 96% of patients operated under GA required injectable analgesics in the immediate postoperative period. Postural headache was experienced by five (7.46%) patients postoperatively. The average time of discharge was 1.9 in patients operated under SA compared with 2.1 days in GA group. There is no risk of intubation-related airway obstruction, little risks of unrecognized hypoglycemia in a diabetic patient, excellent muscle relaxation, decreased surgical bed oozing, and a more rapid return of gut function when LC is done using SA compared with GA.

Prevention of intraoperative miosis in femtosecond laser-assisted phaco surgery

Prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification is a relevant problem of cataract surgery. Development and clinical study of an effective method for preventing intraoperative miosis in hybrid (femtosecond laser-assisted) phacoemulsification. Hybrid phacoemulsification was performed in 300 patients (300 eyes). The first group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day and 3 times in 2 hours before surgery at 30 minute intervals. The second group (100 eyes) 3 days prior to the surgery was prescribed instillations of 0.1% indomethacin 3 times a day, 3 times in 2 hours before the surgery at 30 minute intervals, and 1 hour before the surgery an additional intramuscular injection of diclofenac. The third group (control, 100 eyes) 2 hours before the operation was prescribed instillations of 0.1% indomethacin, 3 times at 30 minute intervals. The diameter of the pupil was evaluated before the beginning of femtosecond laser stage and before the opening of anterior chamber during the second stage of the operation. When the interval between the femtosecond laser stage and emulsification of the nucleus fragments was maintained at less than 15 minutes, pronounced decrease of the pupil (more than 2 mm) was noted in 8.2% of cases in the first group, 6.7% in the second group and 14.1% in third (control) group; mean values of pupil narrowing were 0.68±0.27 mm in the 1st group, 0.63±0.25 mm in the 2nd group, and 0.93±0.39 mm (p<0.05) in the third group. The clinical study showed high efficiency of the proposed methods for prevention of intraoperative miosis in hybrid (femtosecond laser-assisted) phaco surgery. An important factor affecting intraoperative narrowing of the pupil is the time interval between the femtolaser stage of the operation and emulsification of the nucleus fragments, which should not exceed 15 minutes.

Quality of recovery and analgesia after total abdominal hysterectomy under general anesthesia: A randomized controlled trial of TAP block vs epidural analgesia vs parenteral medications.

Background and Aims:Parenteral analgesics and epidural analgesia are two standard options to treat postoperative pain after total abdominal hysterectomy (TAH). Fascial plane blocks such as transversus abdominis plane (TAP) block have gained popularity recently. However, effect of these analgesic regimens on quality of postoperative recovery (QoR) has not been studied. Hence we aimed to assess and compare the QoR with three different postoperative analgesic regimens---parenteral analgesia, epidural analgesia, and TAP block in patients undergoing TAH under general anesthesia.Material and Methods:Sixty female patients undergoing TAH were randomized into three groups of 20 each for postoperative analgesia. Epidural group received boluses of 0.125% bupivacaine for 24 h, parenteral group received injection diclofenac and injection tramadol alternately every 6 h for 24 h, and TAP group received bilateral TAP block with 0.25% bupivacaine at end of operation. QoR was assessed postoperatively by 40-item questionnaire-QOR-40 and pain was assessed by numerical rating scale (NRS).Results:QOR-40 score was comparable across the three groups at 24, 48, and 72 h postoperatively. TAP block prolonged the time to first rescue analgesic (P = 0.02) and reduced the total 24-h postoperative morphine consumption by 2.4 (95% CI: 1.0, 3.8) mg (P = 0.002) and 7.8 (95% CI: 6.4, 9.1) mg (P < 0.001) when compared with epidural and parenteral groups, respectively.Conclusion:The QoR after abdominal hysterectomy is similar with either intravenous analgesics or epidural analgesia or TAP block when used with rescue analgesia to manage postoperative pain. TAP block provides superior analgesia and reduces 24-h morphine consumption when compared with parenteral and epidural analgesia.

Intravitreal diclofenac versus intravitreal bevacizumab in persistent diabetic macular edema: Anatomical and functional outcome

PurposeTo compare the efficacy of diclofenac versus bevacizumab following single intravitreal injection in eyes with persistent diabetic macular edema.MethodsFifty eyes with persistent DME were randomly allocated to intravitreal injection of 500 µg/0.1 ml of diclofenac (N = 20) or 1.25 mg/0.05 mL of bevacizumab (N = 20) or to non-treatment (10 eyes). Preoperative and postoperative visual acuity, central, paracentral macular thickness and intraocular pressure (IOP) were recorded and compared between the three groups up to 4 weeks.ResultsDiclofenac and bevacizumab groups showed statistically significant reduction in central and paracentral macular thickness (diclofenac: p = 0.006, 0.02 and bevacizumab: p = 0.02, 0.01), without statistically significant difference between the two groups. The two groups showed no statistically significant difference in mean visual acuity or mean line improvement. Mean visual acuity improvement didn't reach statistical significance in either group. Diclofenac group showed statistically significant reduced IOP (P = 0.02). Control eyes did not show any change in mean visual acuity, macular thickness or IOP.ConclusionIn persistent DME, diclofenac has a structural effect comparable to bevacizumab on central macular thickness. However, significant functional gain may not be accomplished by single injection. Unlike naïve DME, persistent cases may be confounded by systemic and local factors necessitating repeated injection of diclofenac.

The Comparative effects of Transdermal and Intramuscular Diclofenac for postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Aims and Objectives: To compare the analgesic effectiveness of transdermal diclofenac patch and intramuscular diclofenac in patients undergoing laparoscopic cholecystectomy. To compare the adverse effects of transdermal Diclofenac patch and intramuscular diclofenac. Methods: Sixty ASA I and II patients of either sex aged eighteen to sixty years ready for laparoscopic cholecystectomy were enclosed during this study. Patients were divided into 2 groups, A (n = 30) received transdermal diclofenac patch (100 mg) three hours before surgery B (n = 30) intramuscular diclofenac (75 mg) was given forty five minutes before surgery. Postoperative pain was assessed using Visual Analogue Scale (VAS). Adverse effects were noted over a period of twelve hours. Patients with VAS score greater than 3 received intravenous tramadol 2mg/ kg to relieve pain. Results: In each group the VAS scores were higher for ten hours post surgery. There was no significant difference in the surgical pain in both the groups. There was no significant difference in both the groups statistically for the need of rescue analgesia. Erythema was observed in group A patients whereas pain at injection site and rubor was observed in group B who received the injection diclofenac. Conclusion: Diclofenac skin patch and IM injection are unit comparable in terms of effectiveness for pain relief in surgical laparoscopic cholecystectomy patients. Transdermal patch is thought of as an efficient, non-invasive and value effective means of managing surgical pain.