Intramuscular Injection Of Diclofenac Research Articles

Effectiveness of transdermal diclofenac patch versus intramuscular diclofenac injection in management of pain among patients with rib fracture in a tertiary care hospital

Most common injuries in trauma are rib fractures which leads to increase rick of mortality and morbidity. In India alone, there is are about 10 million cases per year for incidence of rib fractures more commonly due to vehicle accidents whereas 6% are of global accidents in India, itself. The current modality of treatment is with NSAID’s for relief of pain in rib fractures. A prospective study of 203 patients with rib fractures found a prevalence of chronic pain 22% and disability of 53%. Thereby, adequate pain management is crucial for improving the recovery and quality of life. The preferred route of administration of analgesics is either oral or intramuscular. This study entails in determining the effectiveness of transdermal Diclofenac patch versus intramuscular administration of Diclofenac.

A Case of Nonsteroidal Anti-Inflammatory Drug-Induced Anaphylaxis Confirmed by Skin Testing

Nonsteroidal anti-inflammatory drugs (NSAIDs) are collectively a major culprit of drug-induced hypersensitivity. No reliable diagnostic tests, other than a direct challenge, are available for detecting the hypersensitivity. Cross-reactivity among NSAIDs that inhibit cyclooxygenase-1 is common. However, in rare cases, the mechanism underlying hypersensitivity can be understood from the immunological point of view, without involving cross-reactivity of NSAIDs or even with a positive skin test for an NSAID. A 55-year-old woman was referred to the Emergency Department for anaphylaxis. She suffered from generalized hives, chest tightness, and hypotension a few minutes after intramuscular injection of diclofenac. One year ago, she had experienced a similar reaction after intramuscular injection of aceclofenac. Thereafter, she had been taking naproxen as needed to relieve her osteoarthritis pain, without having an adverse reaction. To confirm drug hypersensitivity and to find alternative drugs, provocation tests were performed with acetaminophen, celecoxib, and lysine-aspirin. All tests were negative, and a skin prick test with diclofenac was also negative. However, intradermal injection of 0.05 mL (37.5 mg/mL) diclofenac provoked an anaphylactic shock and resulted in her admission. Here, we report a rare case of single NSAID-induced anaphylaxis, which was only triggered by acetic acid derivatives of NSAIDs, presumably by an immunoglobulin E-mediated reaction.

Post Tonsillectomy Pain Relief: Comparative Study between Peritonsillar Infiltration of Bupivicain and Intramuscular Diclofenac

Hospital based study carried out on (40) patients from both sexes, aged (4-26) years,underwent Tonsillectomy by dissection method during the period extend from (June2012 to September 2012). The Patients were divided into two groups- Group A (18)patients: include those with pre-incisional – infiltration of bupivicain with subsequent(spray) post operatively on Tonsils bed at evening and next morning. Group B (22)patients: include those patients with diclofenac intramuscular injection, half hourbefore operation with subsequent doses at evening and next morning. (Result): nodifference in history of post- operative nausea and vomiting regarding the two groups.The mean operative time for group (A) was (28.9) minutes, while the mean operativetime for group (B) was (29.5) minutes. Both groups showed no difference regardingreactionary bleeding (bleeding occurs within 24 hours) or secondary bleeding(Bleeding occurs after 6-8 days due to infection). Group (A) showed low score of painin immediate post-operative time but it was not significant, while group (B) showedlow score of pain in most of the cases at evening, it was significant. No difference inboth groups in the next morning both showed low score of pain. Conclusion:intramuscular diclofenac is more potent as pain relief if compare with Bupivicaininfiltration. Aim of study: To identify the effect of infiltration of bupivicain for posttonsillectomy pain-relief and in compare to intramuscular injection of diclofenac.

Nicolau syndrome following Intramuscular Diclofenac Injection: a case report and review of the literature

Nicolau syndrome (NS), also referred as embolia cutis medicamentosa and livedo-like dermatitis, is an uncommon complication followed by drugs administered intramuscularly, intraarticularly or subcutaneously. In this case report we present a case of a 65-year-old lady who had a single dose of diclofenac sodium as an intramuscular injection in her left buttock due to back pain that led to developing what known as NS. She was treated with surgical debridement, drain insertion and skin approximation with antibiotics for 2weeks with daily sterile dressing. The wound healed completely with scarring. NS is a preventable outcome, thus, proper procedures and precautions should be taken during intramuscular medication administration. Healthcare providers should avoid unnecessary injections, be familiar with the complication and consider it as a potential diagnosis for severe localized pain after any injection.

Tissue Damage Caused by Diclofenac Intramuscular Injection: The Nicolau Syndrome

Abstract Introduction Nicolau syndrome is an extremely rare complication following intramuscular administration of drugs leading to tissue damage and necrosis. Case Report In this case, the patient received the injection from an untrained quack surgeon (Jarrah) due to an improper intramuscular injection technique. A 45-year-old female complained of pain and blackish discoloration of the skin over the left buttock after receiving an intramuscular diclofenac injection.4 The patient was managed by administering intravenous antibiotics and analgesics, followed by surgical debridement. Flap reconstruction was done after granulation tissue formation. Conclusion Healthcare should be sought from appropriately trained and licensed professionals. Patients should be well educated on this. Pain, erythema, and discoloration should be recognized as red flags of the Nicolau syndrome so that it can be addressed promptly to avoid complications.

Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis

Renal colic is described as one of the worst types of pain, and effective analgesia in the shortest possible time is of paramount importance. To examine whether acupuncture, as an adjunctive therapy to analgesics, could accelerate pain relief in patients with acute renal colic. This single-center, sham-controlled, randomized clinical trial was conducted in an emergency department in China between March 2020 and September 2020. Participants with acute renal colic (visual analog scale [VAS] score ≥4) due to urolithiasis were recruited. Data were analyzed from October 2020 to January 2022. After diagnosis and randomization, all patients received 50 mg/2 mL of diclofenac sodium intramuscular injection immediately followed by 30-minute acupuncture or sham acupuncture. The primary outcome was the response rate at 10 minutes after needle manipulation, which was defined as the proportion of participants whose VAS score decreased by at least 50% from baseline. Secondary outcomes included response rates at 0, 5, 15, 20, 30, 45, and 60 minutes, rescue analgesia, and adverse events. A total of 115 participants were screened and 80 participants (66 men [82.5%]; mean [SD] age, 45.8 [13.8] years) were enrolled, consisting of 40 per group. The response rates at 10 minutes were 77.5% (31 of 40) and 10.0% (4 of 40) in the acupuncture and sham acupuncture groups, respectively. The between-group differences were 67.5% (95% CI, 51.5% to 83.4%; P < .001). The response rates of acupuncture were also significantly higher than sham acupuncture at 0, 5, 15, 20 and 30 minutes, whereas no significant difference was detected at 45 and 60 minutes. However, there was no difference between the 2 groups in rescue analgesia rate (difference 2.5%; 95% CI -8.8% to 13.2%; P > .99). No adverse events occurred during the trial. These findings suggest that acupuncture plus intramuscular injection of diclofenac is safe and provides fast and substantial pain relief for patients with renal colic compared with sham acupuncture in the emergency setting. However, no difference in rescue analgesia was found, possibly because of the ceiling effect caused by subsequent but robust analgesia of diclofenac. Acupuncture can be considered an optional adjunctive therapy in relieving acute renal colic. Chinese Clinical Trial Registry: ChiCTR1900025202.

Hepatoprotective Effect of Coenzyme Q10 in Rats with Diclofenac Toxicity.

The liver and kidney are the most important organs in the body, and they both act as target structures for drug-induced injury as a consequence of their functions in metabolisms, detoxifications, storage, elimination of medications, and their metabolites. The present study aimed to examine the role of the natural and free radical scavenger "CoQ10" against diclofenac-induced hepatic and renal tissue injury. In total, 36 adult Wistar rats were randomly divided into three equal groups (n=12). The animals in the control group did not receive any medication or treatments, and the second group included animals that received intramuscular (IM) injection of Diclofenac (DF) (at a dose of 10 mg/kg once daily for 14 days). Moreover, the third group was given the IM injection of DF (at a dose of 10 mg/kg once daily for 14 days) +CoQ10. After 14 days, DF prompted signified hepatic and renal injury indicated by elevated biochemical parameters, such as total serum bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, and uric acid, compared to the control and the third group. However, the group that received Diclofenac+CoQ10 had significantly lower hepatic and renal dysfunctions, compared to the second treated group. DF toxic effects could be the consequences of mitochondrial dysfunction and free radical effects. Remarkably, therapeutic supplementation of CoQ10 diminished the DF-induced toxic oxidative injury and apoptotic cell death. The protective effects of CoQ10 were attributed to its antioxidants and free radical scavenger activity.

Comparative MRI and Laboratory Evidence of Muscle Injury after Intramuscular Injection of Diclofenac 1 mL and 3 mL: Case Study Reports

Aim &amp; Objectives: Intramuscular (IM) injections of 1 mL and 3 mL Diclofenac 75 mg are used in the clinic in the management of the pain. The present study was performed with the aim to evaluate muscle injury after IM injection of Diclofenac 75 mg/1 mL (Dynapar AQ ® , Troikaa Pharmaceuticals Limited, India) and Diclofenac injection 75 mg/3 mL (commercially available) in subjects using Magnetic Resonance Imaging (MRI) and laboratory blood tests. Material &amp; Methods: Two separate single arm case studies, (each comprising of a single healthy subject) were carried out after Ethics Committee approvals and CTRI Registration. Two subjects who gave written informed consent received either Diclofenac injection 75 mg/1 mL (Dynapar AQ ® , Troikaa Pharmaceuticals Limited, India) OR Diclofenac injection 75 mg/3 mL (commercially available) and the muscle injury was evaluated at different time points up to 14 days. Results: In both the subjects, the intramuscular injury after the injection was reliably documented by MRI and laboratory tests. For the subject who received Diclofenac injection 75 mg/3 mL, there was significant muscle injury observed (T2- weighted magnetic resonance was increased manifold: the volume of muscle injury was 108 mL at 24 hr after injection; 137 mL at 48 hours, and progressive worsening after 48 hours, rising to 271 mL on Day 7 with subsequent normalization at Day 119). However, in the subject who received Diclofenac injection 75 mg/1 mL, muscle injury was relatively minor and reversed quickly at day 7; (T2-weighted magnetic resonance volume of muscle injury was 66 mL at 24 hr after injection, a flatter peak of 69 mL at 48 hours, declining thereafter). In the subject who received 3 mL injection, the CPK levels (Normal range: serum CPK: 39 – 308 U/L by immune assay) were highly increased (from baseline of 47 U/L to 1975 U/L in 8 hours, 1320 U/L at 48 hours, continued elevation after 48 hours: 420 U/L at 7 Days and 267 U/L on Day 119), with prolonged plateau of elevation and gradual decline over weeks indicating significant muscle injury with Diclofenac injection 75 mg/3 mL whereas, in the subjects who received diclofenac injection 75 mg/ 1 mL, there was only minor increase in CPK (from baseline of 93 U/L to 433 U/L in 24 hours) and was normalized to 95 U/L at day 7. In the subject who received Diclofenac injection 75 mg/3 mL, the IL-6 was within the upper range of normal (Normal Range: IL6 0-50 pg/mL by ELISA), and rose from a baseline of &lt; 2 pg/mL to 37.3 pg/mL, but in the subject who received 1 mL IM Diclofenac, values stayed low throughout (&lt;4 pg/mL). Conclusion: There was higher muscle injury following 3 mL Diclofenac intramuscular injection when compared to 1 mL Diclofenac intramuscular injection. This is the first comparative report confirming radiologic and laboratory evidence of muscle injury produced by a 1 mL and 3 mL Diclofenac injection, and opens the door for further research on muscle injury, and focuses our efforts to prevent or minimize the same.

Transdermal Diclofenac Patch versus Intra Muscular Diclofenac Injection for the Management of Pain in the Post Operative Patients in a Teritiary Teaching Institute

Background: Pain management in immediate postoperative period is an extremely important but herculean task. As oral medication is not possible at this stage, it is injectable analgesia which is put to task. In countries like India, where efficacy and cost both count, intramuscular diclofenac is the most commonly employed analgesic. Methodology: The study was cross sectional by using questionnaire in 80 healthy adult subjects of either sex undergoing Hernia correction surgery under spinal anaesthesia. The subjects were assigned into two groups (Group I and Group P) by computer generated randomization table to receive intramuscular diclofenac 75mg or transdermal diclofenac patch 100mg immediately after spinal anaesthesia. The patients were monitored for pain using Visual Analogue Scale. Duration of analgesia and request for rescue analgesic (Tramadol 2mg/kg) were noted in both the groups. The study ended when patients had a VAS &gt; 8 or at first request for analgesic. Result and Conclusion: It was concluded that if applied with proper planning, diclofenac patch was as effective as diclofenac injection but at the same time administration of patch is devoid of pain, local side effects, drug destruction by stomach and digestive enzymes and first pass metabolism in liver.

Efficacy of diclofenac transdermal patch and diclofenac rectal suppository for postoperative pain management following open cholecystectomy: A single blind prospective comparative study

Postoperative pain control is an important component of surgical patient care. Inadequate pain control in postoperative period increases mortality and morbidity to great extent. Studies have shown transdermal diclofenac is as effective as intramuscular diclofenac injection in postoperative analgesia, but a comparison of diclofenac rectal suppository and transdermal route is lacking. This research proposal intends to study and compare the effectiveness of Diclofenac transdermal patch and rectal suppository.Randomized, Single Blind, Prospective, Comparative study.ASA 1 and 2 patients scheduled for open cholecystectomy withsample size60 patients divided between group TD (transdermal patch, n=30) and RS (rectal suppository, n=30). 100 mg diclofenac epolamine patch was applied on inner aspect of left arm in TD group’s 1hr before incision Patch was changed 12hrly for 48 hrs. 100 mg diclofenac sodium was introduced per-rectally in PR group just before induction of anesthesia and repeated 12hrly for 48hrs. Each patient was monitored and data collected in PACU, PCA remote was again shown to patients and advised them to press button whenever they feel.It has been found that both the groups were comparable in their demographic distribution, in terms of age and sex. 14 readings were taken from just after OT till 48hrs from starting surgery. None of the patients in the study showed the sign or symptoms of opioid overdosing. The pain was better controlled with Diclofenac through per rectal route than the transdermal route.Considering mean rank of VAS till 6hrs after skin incision and drugs given during 1, 2 and 3 readings at 6 hr., 12 hr., 18 hr. and continue 6hrly and total drugs given till 48hrs, pain after open cholecystectomy was better controlled with diclofenac sodium rectal suppository in comparison to diclofenac epolamine patch.

To evaluate efficacy and safety of diclofenac transdermal patch with intramuscular diclofenac injection as preemptive analgesia in post operative patients undergoing inguinal hernioplasty

To evaluate efficacy and safety of diclofenac transdermal patch with intramuscular diclofenac injection as preemptive analgesia in post operative patients undergoing inguinal hernioplasty. : We aim to compare the duration and quality of analgesia provided by diclofenac trans dermal patch and intramuscular injection and to estimate time at which patients demand rescue analgesia after surgery.: This randomized comparative study was conducted at a tertiary care hospital in central India. : 60 healthy patients divided into two groups of 30 each, scheduled for elective inguinal hernioplasty under subarachnoid block were taken. Sample size calculation was based on the difference of means of two independent samples. A transdermal diclofenac patch containing 100 mg of diclofenac diethylamine was applied to the participants in the study group just before the induction of anesthesia. In the control group, 75 mg of diclofenac sodium Inj. was given intramuscularly half-an-hour before the end of surgery.Data for postoperative pain was assessed at 2, 4, 6, 8, 12, 16 and 24 hours by using a visual analogue scale (VAS) score and verbal rating scale (VRS) score and analysed using upaired t test.: Statistical difference in duration, quality of pre-emptive analgesia and Significant time of rescue analgesia was found between the two groups in terms of postoperative pain in patients undergoing inguinal hernioplasty. Tran dermal diclofenac patch (100 mg) is a better analgesic route than intramuscular diclofenac sodium (75 mg) for pre-emptive analgesia in patients undergoing inguinal hernioplasty.

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 &amp; 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

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.

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.&#x0D; Objectives: To assess the efficacy of intramuscular injection of diclofenac sodium in preventing succinylcholine-induced myalgia.&#x0D; 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.&#x0D; Results:The demographic data for both groups were comparable (p &gt; 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 &lt; 0.05). Conclusion: Prophylactic use of intramuscular injection of diclofenac is effective in the prevention of postoperative myalgia&#x0D; KYAMC Journal Vol. 10, No.-1, April 2019, Page 35-38

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.

The efficacy of diclofenac for post caesarean section analgesia: Comparison of rectal and intramuscular routes

Background: Despite advances in postoperative pain therapy, pain relief may still be inadequate for a substantial number of women.Aim: The aim was to compare the analgesic efficacy of rectal and intramuscular diclofenac for post Caesarean section analgesia.Materials and Methods: Following approval from the Hospital Ethics Committee 94 ASA I and II parturients aged 18 years and above scheduled for elective Caesarean section under spinal anaesthesia were recruited into the study. While one group of parturients received 100 mg Diclofenac suppository rectally (group R) those in the other group received 75 mg Diclofenac intramuscularly (group IM) immediately after surgery. The patients were instructed to request analgesic when they felt pain post-operatively. Pain scores were recorded using the VAS (0 to 10), (0 = no pain, 10 = the most severe pain), initially every 30 minutes for the first 2 hours, then every 2 hours from the 2nd hour to the 8th hour and every 4 hours after the 8th hour till the 24th hour.Results: The demographic data, BMI, PCV and ASA classification between the two groups of patients were comparable; the two groups were also comparable in the haemodynamic variables (mean systolic BP, mean diastolic BP, mean MAP and mean heart rate) and in the mean SpO2 recorded in the recovery room, p > 0.05 for all the variables. The time to first analgesic request in group IM was 313.2 ± 218.8 mins and in group R 314.1 ± 121.6 mins, p=0.98. There was no significant difference between the IM/R groups in the mean VAS scores of patients, the number of patients who received pentazocine at each time interval in the two groups, and the total pentazocine consumption in the two groups in 24 hours, p>0.05 in all the variables. There was no significant difference between the two groups in the mean satisfaction score in pain relief, p = 0.73, the mean satisfaction score with staff's response to patient's pain management needs, p = 0.85, and the mean acceptability score, p = 0.62.Conclusion: Suppository diclofenac administered through the rectal route is as efficacious as intramuscular diclofenac injection for post Caesarean section analgesia with equal levels of patient satisfaction and acceptability.Keywords: Post Caesarean section analgesia, diclofenac, rectal, intramuscular, spinal anaesthesia,

Muscle Injury After Intramuscular Administration of Diclofenac: A Case Report Supported by Magnetic Resonance Imaging

Intramuscular injection of diclofenac is still frequently practiced, although there is ample evidence that the risk of local tissue intolerability is highly underestimated. The aim of this study was to evaluate local toxicity in a patient using magnetic resonance imaging. A patient who gave written informed consent received a medically indicated intramuscular administration of diclofenac 75 mg/2 mL. Simultaneously with magnetic resonance imaging of the depot, a clinical–chemical evaluation and quantification of diclofenac in plasma was performed. A manifold enhancement of the T2-weighted magnetic resonance signal was observed in a muscle area of approximately 60 mL volume, with maximum signal intensity 30 min after injection, the time of maximum diclofenac plasma exposure. Plasma creatine kinase activity was elevated approximately sixfold within 8 h and normalized within 1 week, whereas the magnetic resonance enhancement disappeared within 5 weeks. Interestingly, the patient did not complain about any clinical symptoms at the injection site. Asymptomatic tissue injury after intramuscular injection of diclofenac, caused by intramuscular dosing, can be reliably evaluated by magnetic resonance imaging and should be applied early during the development of parenteral dosage forms. Clinical Trials Registration Number: BB130/16 (Ethics Committee of the University Medicine Greifswald).

Sciatic nerve injury following analgesic drug injection in rats: A histopathological examination.

OBJECTIVE:Sciatic nerve neuropathy can be observed following intramuscular gluteal injections. The histopathological examination of sciatic nerve damage following intramuscular injection in the gluteal region for acute pain treatment is not feasible in humans due to the inability to dissect and examine the nerve tissue. To overcome this issue, we used a rat model for demonstrating damage to the sciatic nerve tissue after the application of commonly used drug injections.METHODS:We investigated possible damage following the intramuscular injection of diclofenac, lornoxicam, morphine, and pethidine in a rat model based on histopathological characteristics such as myelin degeneration, axon degeneration, epineurium degeneration, fibrosis, epineurium thickening, perineurium thickening, lymphocyte infiltration, vacuolization, and edema.RESULTS:All the analgesic drugs used in our study induced histopathological changes in the sciatic nerve. Anti-S100 positivity, showing nerve damage, was found to be the lowest in the group treated with diclofenac. Neurotoxic effects of diclofenac on the sciatic nerve were greater than those of the other drugs used in the study. Lornoxicam induced the least histopathological changes in the nerve.CONCLUSION:Diclofenac induced severe nerve damage not only after direct injection in the sciatic nerve but also after injection in the area around the nerve. Thus, we recommend restricting the use of intramuscular gluteal injections of diclofenac. Intramuscular use of morphine and pethidine should also be overviewed.

Post Operative Pain Relief: Comparison of Transdermal DiclofenacPatch with Intra Muscular Diclofenac Injection

Purpose of study: This study was done to evaluate transdermal diclofenac patch as pre-emptive analgesic in providing post-operative analgesia in Hernia correction surgeries, compared to intramuscular diclofenac injection. Methodology: The study was cross sectional by using questionnaire in 60 healthy adult subjects of either sex undergoing Hernia correction surgery under spinal anaesthesia .The subjects were assigned into two groups (Group DI and Group DP) by computer generated randomization table to receive intramuscular diclofenac 75mg or transdermal diclofenac patch 100mg immediately after spinal anaesthesia. The patients were monitored for pain at 2,6 and 12 hours post-operatively using Visual Analogue Scale. Duration of analgesia and request for rescue analgesic (Tramadol 2mg/kg) were noted in both the groups. The study ended when patients had a VAS > 8 or at first request for analgesic. Results: The mean duration of analgesia in group DI was 8.9±2.16 hours and in the group DP was 10.28±2.54 hours. Conclusion: Preoperative application of single dose of transdermal diclofenac patch 100mg provides prolonged analgesia compared to single dose of intramuscular diclofenac 75 mg for acute post-operative pain, without any significant side effects. Key words: Transdermal Diclofenac, IntraMuscular Diclofenac, Post operative pain relief, Hernia surgeries

Nicolau syndrome: A rarely seen iatrogenic fatal cutaneous reaction following intramuscular diclofenac injection

Nicolau syndrome, also known as embolia cutis medicamentosa or livedoid dermatitis, is a rare cutaneous adverse drug reaction seen at the site of injection of some particular drugs. It was first reported by Freudenthal in 1924 and Nicolau in 1925 as an adverse effect of bismuth salts used in syphilis. Typically, this syndrome is clinically manifested by intense burning or stabbing pain at the site of injection and retiform hemorrhagic patches with or without vesiculations and ulceration with a variable degree of tissue necrosis. To the best of our knowledge, <50 cases of Nicolau syndrome have been reported in medical literature which occurred following intramuscular administration of diclofenac sodium. Here, we report a 26-year-old female typically presenting with pathognomic signs and symptoms of NS after taking intramuscular injection of diclofenac.