Intramuscular Diclofenac Research Articles

Randomized clinical trial comparing the effect of paracetamol with diclofenac in combination with on request rescue analgesic tramadol: analgesic efficacy, safety and tolerability after abdominal surgery

Background: The study was planned to assess the efficacy and safety of paracetamol in comparison with diclofenac for post-operative analgesic pain in patients undergoing elective abdominal surgery. This, randomized clinical trial was conducted in an institution of medical education and tertiary care centre. Methods: 90 patients scheduled for elective abdominal surgery were assigned in a randomized manner in to two groups. Group P received 1 g paracetamol intravenously (IV) 8 hourly and group D received 75 mg intramuscular (IM) diclofenac 8 th hourly for 24 hr post‑operative period. The pain intensity was judged using pain visual analogue score (VAS) at time periods 2h, 4h, 6h, 12h, 18h and 24h post-surgery. Patient reported with a VAS pain score of greater than 3, a rescue analgesic IV tramadol 100 mg injection was given. The need of rescue analgesic, pain VAS, patient satisfaction score and adverse effects were recorded. Results: The data was expressed in mean +/-SD and analysed using unpaired t test, chi-square test, followed by Fisher’s exact post-hoc test. Total tramadol requirement were not significantly different between paracetamol and diclofenac groups. Gastrointestinal side effects were present in 6.6% and 17.7% of patients receiving paracetamol and diclofenac respectively. Patient satisfaction score till administration of rescue analgesics showed statistically significant difference (p=0.043) between the groups. Conclusions: Paracetamol is equally effective and safer which can be a practicable alternative compared to Diclofenac especially because of its highly encouraging risk benefit-ratio, which justify its role as a near-routine management for post-operative pain.

Comparative Evaluation of Preemptive Analgesic Effect of Injected Intramuscular Diclofenac and Ketorolac after Third Molar Surgery- A Randomized Controlled Trial.

Analgesia pre-emptively administered effect-ively aid in management of pain. Pre-emptive analgesia is anti-nociceptive treatment which prevents altered central sensitization of afferent inputs. To compare and evaluate the pre-emptive analgesic efficacy of preoperatively administered ketorolac and diclofenac for controlling postoperative pain after third molar surgery. A total of 50 patients with symmetrically impacted third molars were divided into two groups, 30mg intramuscular injection of ketorolac and 75 mg diclofenac sodium were used in the respective groups. The visual analogue scale was used to assess post operative pain for three days and the patients were also evaluated for the number of rescue analgesia. The data was statistically evaluated with paired t- test. The maximum time taken for pain perception for Group A Ketoralac was 5.48 hrs and Group B Diclofenac sodium was 4.9 hrs and p=0.235 which was not significant. The mean number of tablets taken by the patients in the first three post operative days was 3.24 in Group A i.e., Ketorolac and 4.04 in Group B i.e., Diclofenac sodium. The values were compared using the paired t test. The p value = 0.004, which was significant. Ketoralac showed better pre-emptive analgesic effect for post-operative pain management after third molar extraction. The immediate post-operative pain free period provided by both ketorolac and diclofenac by intramuscular route was same.

Rectal or intramuscular diclofenac reduces the incidence of pancreatitis afterendoscopic retrograde cholangiopancreatography.

Acute pancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to evaluate the efficacy of intramuscular diclofenac sodium for prophylaxis of post-ERCP pancreatitis (PEP) in comparison to the rectal form. One hundred and fifty consecutive patients who underwent ERCP were enrolled in this single-center, prospective, randomized controlled study. Patients were randomized into three groups. The first group received 75 mg of diclofenac sodium via intramuscular route and the second group received 100 mg of diclofenac sodium rectally 30-90 min before the procedure. The third group served as the control group. Patients were evaluated for post-ERCP pancreatitis with serum amylase levels and abdominal pain 24 h after the procedure. The overall incidence of PEP was 6% (n = 9) and 2% (n = 1) in the intramuscular (IM) and rectal groups, respectively, and 14% in the control group (P = 0.014). Nineteen (12.7%) patients developed post-ERCP abdominal pain (8% in IM, 10% in rectal, and 20% in control group; P = 0.154). Twenty-five (16.6%) patients developed post-ERCP hyperamylasemia (10% in IM, 12% in rectal, and 24% in control group; P = 0.03). Prophylaxis with diclofenac given rectally or intramuscularly is an effective option for the management of post-ERCP pancreatitis.

Efficacy and safety of transdermal diclofenac patch versus intramuscular diclofenac injections in postoperative patients of inguinal hernia

Background: The aim of this study was to compare the efficacy and safety of diclofenac transdermal patch with intramuscular diclofenac injections in postoperative patients of inguinal hernia. Methods: Sixty male participants scheduled for surgery of inguinal hernia were equally randomized into two groups. A transdermal diclofenac patch 100 mg was applied to the participants in the study group 3 hours prior to surgery. In the control group, 2 doses of 75 mg diclofenac sodium injections were given intramuscularly, first dose 2 hours after the surgery and second dose after 12 hours. Pain was assessed postoperatively after an interval of every six hours for 24 hours using visual analogue scale (VAS) and verbal rating scale (VRS). Tramadol 50 mg slow intravenous injection was administered as rescue analgesic. Patients were withdrawn from the study when they asked for rescue analgesia, or when the VAS score was >5 and VRS >2. Data were analysed using unpaired student’s‘ t ’ test. Results: Both diclofenac patch and intramuscular injections produced effective analgesia. A gradual increase in pain score was observed for diclofenac patch as compared to intramuscular injections 18 hours after the surgery. Diclofenac patch was well tolerated without any significant side effects. Conclusions: Transdermal diclofenac patch can be considered as safe and effective method of pain management in postoperative patients of inguinal hernia. But diclofenac intramuscular injection provided better pain relief compared to diclofenac transdermal patch.

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.

Effects of diclofenac sodium on the hippocampus of rats with acute subdural hematoma: histological, stereological, and molecular approach.

This study was aimed at evaluating the potential effects of acute subdural hematoma (ASDH) and diclofenac sodium (DS) therapy following ASDH on the rat hippocampus. Twenty-four male Sprague Dawley rats were used and divided into four groups. 0.1 ml of non-heparinized autologous blood from the tail vein of the animals in the non-treatment group (NTG) and treatment group (TG) was injected into the subdural space. The TG received intramuscular diclofenac sodium at a 15 mg/kg dose daily from the postoperative second hour to the seventh day after the operation. The control group (CG) and sham group (SG) were used for control and sham operations, respectively. On the postoperative eighth day, all animals were sacrificed, and the hippocampi of all animals were stereologically and histologically evaluated. Also blood samples of the animals were biochemically analyzed. As a result of the study, the mean number of neurons in CA1, CA2, and CA3 regions of the hippocampus and the total number of neurons were decreased in the hippocampus samples of the NTG and especially the TG subjects. When comparing the second blood samples, there was no difference between the levels of adrenaline and serotonin among the groups. However, after the operation, noradrenalin levels in the treatment group were found to be higher than those of the sham and control groups (p < 0.05). In the NTG and TG, histopathological findings were observed such as Nissl condensation as well as completely dead and indistinguishable neurons with abnormally shaped, shrunken cytoplasm and nuclei. Also necrotic areas on the specimens of the TG were seen. In immunohistochemical sections, c-FOS positivity was decreased in the NTG and especially the TG. Otherwise, PGC-1 positive cells were increased in the NTG and especially the TG. In this study, it was shown for the first time by means of stereological techniques that using DS after ASDH caused a decrease in the number of hippocampal neurons (CA1, CA2, and CA3 regions).

Diclofenac sodium injection (Akis®, Dicloin®) in the management of pain: a guide to its use in the EU

A novel formulation of diclofenac sodium suitable for subcutaneous (SC) or intramuscular (IM) injection (Akis®, Dicloin®) has been developed using the complexing agent hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer. Diclofenac HPβCD is available in several European countries, where it is indicated for use in adults with acute forms of pain, including postoperative pain. In clinical trials, SC or IM diclofenac HPβCD demonstrated analgesic efficacy in moderate to severe acute postoperative pain following dental surgery or minor orthopaedic surgery, and in moderate to severe neuropathic pain. Diclofenac HPβCD was generally well tolerated. Although injection-site reactions were among the most commonly reported adverse events with diclofenac HPβCD, its local tolerability profile was consistently rated as ‘good’ or ‘excellent’ across all studies. SC administration of diclofenac is a valid alternative to IM delivery, with the advantages of easier administration, the availability of additional body sites suitable for injection and the potential for self-administration. Thus, diclofenac HPβCD 25, 50 or 75 mg/mL solution for SC or IM injection extends the treatment options available for use in the management of acute pain in adults.

Comparison of ultrasound guided transversus abdominis plane block versus local wound infiltration for post operative analgesia in patients undergoing gynaecological surgery under general anaesthesia.

Transversus abdominis plane block has been recently developed as a part of multimodal post operative analgesic techniques. We compared the analgesic efficacy of this technique with local bupivacaine infiltration in patients undergoing gynaecological surgeries with pfannenstiel incision and lower midline incision under general anaesthesia. To evaluate the efficacy of ultrasound guided transversus abdominis plane block for postoperative analgesia. Patients were randomly allocated to three groups: control group (n=15), transversus abdominis plane block group (n=15), who received bilateral transversus abdominis plane blockwith 0.25% bupivacaine, and local infiltration group (n=15), who received local wound infiltration with 0.25% bupivacaine at the end of surgery. All patients received intramuscular diclofenac 12 hourly and intravenous tramadol SOS in the postoperative period. Visual analogue scores for pain were assessed at 1,2,4,8,12 and 24 hours postoperatively and these were compared between the three groups. Average tramadol consumption in 24 hours were also compared among the three groups. Data were subjected to univariate ANOVA test and chi-square test. Level of significance was set at 0.05. Visual analogue scores were significantly less in transversus abdominis plane block group and effect lasted up to 12 hours at rest postoperatively and 8 hours during cough and movement. Bilateral Transversus abdominis plane block was effective in reducing postoperative pain scores for 8 to 12 hours postoperatively. This block was also successful in reducing postoperative opioid requirement.

Drug utilization pattern of NSAIDs assessed with the anatomical therapeutic chemical classification/defined daily dose system in an orthopedic department

To study the drug utilization pattern of NSAIDs using the Anatomical Therapeutic Chemical classification/Defined Daily Dose (ATC/DDD) system in patients admitted to the orthopedic department of a tertiary-care teaching hospital. A cross-sectional prospective observational study was carried out in 200 patients from March to August 2014. Demographic information, disease related details, drug history and adverse drug reactions (ADRs) were recorded by personal interview and from case files daily for drug utilization analysis. The majority of patients were aged 18–30 years (30 %), most were male (80 %) and the most common orthopaedic condition causing hospitalization was fracture/dislocation (77 %). The most commonly prescribed drug group was analgesics, with NSAIDs being the most commonly prescribed type of analgesic (97 %). The majority of prescribed drugs were from the World Health Organization (WHO) Essential Medicine List (92 %) and Indian national essential drug list (100 %). Polypharmacy and high polypharmacy was reported in 71 and 14.5 % of patients respectively. No fixed-dose combinations of analgesics were used. Oral tablet diclofenac (M01AB05) 50 mg was the most frequently prescribed analgesic (97 % of patients; 840.5 DDD), followed by intravenous injection tramadol (N02AX02) in 56 % (189.3 DDD), intramuscular injection diclofenac (M01AB05) 75 mg in 55 % (87 DDD) and oral tablet paracetamol (N02BE01) 500 mg in 38.5 % (58.3 DDD) of patients. ADRs (mainly gastritis despite concomitant use of histamine H2 blockers) were reported in 4 % of patients; all ADRs were of ‘possible’ category according to the WHO–Uppsala Monitoring Centre causality assessment method. Fracture-dislocation and arthritis were the most common causes for hospitalization in the orthopedic department. Selection of analgesics and their dosage regimen complied with the WHO guidelines of pain management.

Per-rectal diclofenac decreases the risk of post-ERCP pancreatitis: What about intramuscular diclofenac?

Per-rectal diclofenac decreases the risk of post-ERCP pancreatitis: What about intramuscular diclofenac?

Randomized double blinded placebo controlled trial comparing diclofenac and piroxicam in management of acute renal colic and its clinical implications.

To compare the efficacy of sublingual piroxicam 40 mg with intramuscular diclofenac 75 mg in treatment of acute renal colic. The secondary objective was to look for factors that can affect the severity of the pain and pain relief in acute renal colic. One hundred patients with acute renal colic were randomized into two groups. Group A (n = 50) received intramuscular diclofenac and sublingual methylcobalamin. Group B (n = 50) received sublingual piroxicam 40 mg and intramuscular distilled water. Pain severity was measured using Visual Analog Scale (VAS) and verbal and facial response scales. They were followed up for 3 h. Intramuscular injection of pentazocine 30 mg with promethazine 25 mg were used as rescue drugs. Both groups were comparable for age, sex distribution, body mass index (BMI), and pain duration before presentation. Significant pain relief was noticed in both groups. Sixteen percent in group A and 18% in group B had complete pain relief within 30 min (P = .75). Fifteen patients in group A and 13 patients in group B needed rescue drugs, 84% of group A and 76% of group B had complete pain relief at the end of 3 hours (P = .25). Decrease in pain by each scoring method was also comparable (P = .75). In multiple regression analysis, increasing age, positively affects the severity of pain and pain relief while increasing BMI negatively affect the initial pain relief. Acute renal colic seems to affect men more commonly than women, 81% of the study population were men. Patients with low initial pain score did not require any additional pain relief. Average pain duration before presenting to hospital is 260 min. Sixty percent of renal colics are due to stones below pelvic brim. The results show that sublingual piroxicam is as effective as intramuscular diclofenac. It can be easily self-administered and it overcomes the morbidity and time delay in getting intramuscular diclofenac.

Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic

ObjectiveThe objective is to compare the analgesic effects of diclofenac, acetaminophen, and acupuncture in urolithiasis-driven renal colic pain relief. MethodsRenal colic patients were divided randomly into 3 groups. Patients in group I (n = 40) were treated with intravenous acetaminophen, those in group II (n = 41) with acupuncture, and those in group III (n = 40) with a 75-mg intramuscular injection diclofenac sodium. Visual analogue scale (VAS) and verbal rating scale (VRS) were used to assess pain intensity after 10, 30, 60, and 120 minutes. ResultsNo significant differences in baseline VAS or VRS were found with regard to age or sex. After 10 minutes, all 3 groups experienced a significant decrease in VAS and VRS scores, with the most drastic decrease occurring in group II. After 30 minutes, there was a significantly higher decrease in group III than in group I (P = .001). After 60 minutes, mean VAS scores of groups I and III (P = .753) were similar. The mean VAS score of group III was lower than that of group II (P = .013). After 120 minutes, the difference in the VAS scores was (P = .000) between groups I and II and between groups II and III. Yet, the VAS evaluation made after 120 minutes revealed statistically similar outcomes for groups I and III (P = .488). The statistical findings for VRS evaluations made after 10, 30, 60, and 120 were similar to those for VAS. ConclusionsIn renal colic patients with a possible nonsteroidal anti-inflammatory drug and acetaminophen side effect risk, acupuncture emerges as an alternative treatment modality.

Flexible fibreoptic bronchoscope and the difficult airway: A case report

BACKGROUND: Management of the difficult airway will always confront the anaesthetist. This is one area of the practice that the anaesthetist is required to develop divers skills suited for each clinical situation. The ability to use the flexible fibreoptic bronchoscope (FOB) presents the anaesthetist with an addition tool to conduct endotracheal intubation when faced with a difficult airway.&#x0D; OBJECTIVE: To demonstrate the effectiveness of the flexible fibreoptic bronchoscope in the management of the difficult airway.&#x0D; CASE REPORT: A 21-year old male farmer who presented with a 2-year history of a slowly increasing left-sided jaw swelling. The swelling was painless with protrusion into the oral cavity. There was limited mouth opening but no history of trauma. Examination revealed a clinically ill-looking patient who was not in respiratory distress. Interincisor distance was less than 3cm with associated dental anarchy and a large tumour mass in the oral cavity. Cardiorespiratory findings were within normal limits. Radiology revealed translucency of the mandible with multiloculated “soap bubble” appearance. Histology showed typical characteristics of ameloblastoma of the plexiform type.The flexible FOB was checked before the patient was bought into the theatre. An intravenous access was established and a multi-parameter monitor was attached to the patient. Baseline vital signs were within normal limits. Premedication was with intravenous atropine, diazepam and fentanyl.Using a combination of inhalational and airway anaesthesia, with patient breathing spontaneously, flexible FOB was used to effect right nasotracheal intubation with a size 7.0mm cuffed endotracheal tube. The cuff was inflated and the tube secured with adhesive tape. Anaesthesia was augmented with sodium thiopentone and pancuronium bromide was given to achieve muscle relaxation. Left-hemimandibulectomy was done with disarticulation of the left temporomandibular joint. The patient was extubated fully awake after suctioning and reversal of residual relaxation. Postoperative analgesia was with intramuscular pentazocine and diclofenac. The patient was discharged home after ten days.&#x0D; CONCLUSION: The use of the flexible FOB can be very effective in the management of the difficult airway and the modern anaesthetist must strive to acquire the necessary skill needed to use it.

A comparative study of a combination of paracetamol infusion (perfalgan) and intramuscular diclofenac versus intravenous pethidine, in the management of post caesarean pain

There is growing increase in the rate of caesarean section delivery. Opioid analgesic use, one of the corner stone options is limited by the development of adverse effects. This study evaluated the efficacy of a multimodal method of pain management with or without opioid analgesic. Sixty four pregnant women scheduled for elective caesarean section under spinal anesthesia, were randomized to two groups of 32 subjects each. Group PD received 1gm of intravenous paracetamol infusion and 75mg of intramuscular diclofenac while group P received 50mg of IV pethidine at the end of surgery. Both groups also had wound infiltration with 20mls of 0.1% plain bupivacaine (20mg) after skin closure. The proportion of patients who had VAS of d"3 at various time intervals, time to first analgesic request, patient's satisfaction and side effects/ wound break down were compared. There was no statistical difference between the proportions of patients that were pain free at various time intervals over a period of 24 hours post- operatively, the time to first analgesic request between the groups was not statistically significant. The duration was 242±2.1minutes for the PD group and 181.7±22.1minutes for P group. (P value=0.28). Higher incidences of side effects were observed in the P group with no statistical differences. Patients' satisfaction was better in the PD group compared to the P group. The study demonstrates that a combination of paracetamol infusion and intramuscular diclofenac has similar analgesic efficacy as intravenous pethidine. This combination can be a good substitute for pethidine.

Diclofenac patch: a better alternative to injectable diclofenac in postoperative pain management

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. It is painful and full of side effects. As ideal analgesic is still an illusion, so search for it comes out with some option which is better than the existing ones. Methods: In a similar effort we compared the analgesic effects of diclofenac transdermal patch (100mg)-Nupatch and diclofenac intramuscular injection (75 mg) in the management of post-operative pain in terms of efficacy, duration, quality of analgesia on visual analogue scale and adverse effects of both in short term use. Results: 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 & digestive enzymes and first pass metabolism in liver. Conclusions: Inspite of so many advantages being offered by patch, its use in routine practice is not so common. Probably it is due to lack of awareness and a mental inertia to accept a new concept among medical professionals. This issue needs to be addressed by continuous usage of it by the people who are familiar with its use and popularising it among others.

El papel de la enfermera en el cuidado de los pacientes sometidos a colangiopancreatografía retrógrada endoscópica (CPRE)

This article summarizes the study entitled Efficacy of intramuscular diclofenac in the prevention of post Endoscopic Retrograde Cholangiopancreatography Pancreatitis (ERCP),random clinical test double-blind exploratory, conducted at two Health Institutions in Medellin (Colombia) between 2010 and 2011 During this study we had the opportunity to verify the absence of a nurse during the ERCP procedure and the lack of protocols in endoscopy units. We present a broad illustration of the procedure, possible complications, endoscopic nursing history, and the role of the nurse in the attention of patients undergoing endoscopic retrograde cholangiopancreatography, specifying the functions to be performed by the nurse. A guide is then proposed with the steps to be followed by the nurse during each moment of the test, in order to provide quality care. We conclude about the necessity to train professionals in the nursing field in all aspects related to this test, given the importance to have the assistance of such professionals during the ERCP procedure.

English

English

Is intra-articular magnesium effective for postoperative analgesia in arthroscopic shoulder surgery?

Various medications are used intra-articularly for postoperative pain reduction after arthroscopic shoulder surgery. Magnesium, a N-methyl-D-aspartate receptor antagonist, may be effective for reduction of both postoperative pain scores and analgesic requirements. A total of 67 patients undergoing arthroscopic shoulder surgery were divided randomly into two groups to receive intra-articular injections of either 10 mL magnesium sulphate (100 mg⁄mL; group M, n=34) or 10 mL of normal saline (group C, n=33). The analgesic effect was estimated using a visual analogue scale 1 h, 2 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesia was maintained by intra-articular morphine (0.01%, 10 mg) + bupivacaine (0.5%, 100 mL) patient-controlled analgesia device as a 1 mL infusion with a 1 mL bolus dose and 15 min lock-out time; for visual analogue scale scores >5, intramuscular diclofenac sodium 75 mg was administered as needed during the study period (maximum two times). Intra-articular magnesium resulted in a significant reduction in pain scores in group M compared with group C 1 h, 2 h, 6 h, 8 h and 12 h after the end of surgery, respectively, at rest and with passive motion. Total diclofenac consumption and intra-articular morphine + bupivacaine consumption were significantly lower in group M. Postoperative serum magnesium levels were significantly higher in group M, but were within the normal range. Magnesium causes a reduction in postoperative pain in comparison to saline when administered intra-articularly after arthroscopic shoulder surgery, and has no serious side effects.

Comparison of intrathecal magnesium, dexmedetomidine, or placebo combined with bupivacaine 0.5% for patients with mild pre-eclampsia undergoing cesarean section

Background Neuraxial anesthesia for pre-eclamptic patients undergoing cesarean section is a well-established safe and effective anesthetic technique. Several agents had been studied as adjuvants to commonly used intrathecal drugs. Aim The aim of this prospective, randomized, double-blinded placebo-controlled study is to compare intrathecal magnesium versus dexmedetomidine (DXM) combined with bupivacaine 0.5% for parturients with mild pre-eclampsia undergoing cesarean section in terms of duration of spinal block as a primary outcome and postoperative analgesia and incidence of intraoperative side effects as secondary outcomes. Patients and methods Ninety pregnant women with singleton pregnancies, scheduled for elective cesarean section and diagnosed with mild pre-eclampsia, were enrolled in this prospective, randomized-controlled double-blind study. Lumbar puncture was performed and then patients were allocated to three groups: group D [0.5% hyperbaric bupivacaine 2.5 ml and 0.1 ml (10 μg) preservative-free DXM]; group M [0.5% hyperbaric bupivacaine 2.5 ml and 0.1 ml preservative-free 10% magnesium sulfate (10 mg)]; and group C (0.5% hyperbaric bupivacaine 2.5 ml and preservative-free saline 0.1 ml as a control). Duration of sensory block, motor block, maximal level of sensory block, and duration of spinal anesthesia were recorded. The incidences of hypotension, sedation, nausea, and vomiting were noted every 15 min during surgery. Pain was assessed using a verbal numeric scale from 0 to 10 at 2, 4, 8, 12, 18, and 24 h postoperatively. Intramuscular diclofenac 75 mg was administered for rescue analgesia whenever the pain score was greater than 3. Overall patient satisfaction with anesthesia and analgesia was recorded at 24 h as 1 = excellent; 2 = good; and 3 = poor. Results The three groups were comparable with respect to patients' demographics, gestational age, and duration of surgery. The duration of sensory block, motor block, and spinal anesthesia were prolonged in group M (175.2 ± 19.4, 216.3 ± 12.6, and 200.3 ± 6.4 min) compared with group D (153 ± 4.78, 181.7 ± 7.8, and 160.4 ± 7 min) and group C (150.37 ± 8.8, 171 ± 8.1, and 165 ± 5.83 min), P P P Conclusion The addition of intrathecal magnesium sulfate (10 mg) to bupivacaine in patients with mild pre-eclampsia undergoing cesarean section prolongs the duration of analgesia and reduces postoperative analgesic requirements without additional side effects compared with intrathecal DXM (10 μg).

The efficacy of intranasal desmopressin as an adjuvant in the acute renal colic pain management.

The aim of this study was to compare analgesic effect of intramuscular (IM) sodium diclofenac and intranasal desmopressin combination with IM sodium diclofenac alone in patients with acute renal colic. In this randomized double-blind clinical trial, all patients aged 18 to 55 years who were diagnosed as acute renal colic and met the inclusion and exclusion criteria were randomized into two groups to receive 40 μg intranasal desmopressin spray and 75 mg IM sodium diclofenac combination (Group A) or 75 mg IM sodium diclofenac alone (Group B). The pain score of patients was assessed using a visual analogue scale (VAS) at baseline, 15, 30, 45, and 60 minutes after administration. Of all 159 patients who were assessed for eligibility finally, the results of 120 patients were analyzed. There was no significant difference regarding age and gender between two groups. The baseline VAS score was not significantly different between two groups (P = 0.44). The Mean ± SD scores of two groups reduced 15 minutes after drug administration, but this decrease was significantly more in Group A compared with Group B (P = 0.02). This pattern continued in minutes 30, 45, and 60 of drug administration. Our results showed that desmopressin could be used as an effective adjuvant in acute renal colic pain management.