Intramuscular Diclofenac Research Articles

Intramuscular diclofenac for the prevention of post-ERCP pancreatitis: a randomized trial.

Rectal nonsteroidal anti-inflammatory drugs have been shown to reduce the incidence of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The aim of this study was to determine whether intramuscular diclofenac reduces the risk of PEP. Patients who underwent ERCP were randomized to receive either 90 mg of diclofenac or placebo by intramuscular injection immediately after the procedure. PEP was defined as elevated serum amylase levels (at least three times the upper limit of normal 24 hours after the procedure) associated with new or worsened upper abdominal, epigastric, or back pain. In total, 380 patients were randomized, and 343 were eligible for analysis. The two groups were similar regarding clinical and demographic factors, as well as patient- and procedure-related risk factors for PEP. PEP developed in 20/170 patients (11.8 %) in the placebo group and in 22/173 patients (12.7 %) in the diclofenac group (P = 0.87). Multivariate regression analysis failed to illustrate that intramuscular diclofenac prevented PEP (odds ratio 0.79; 95 % confidence interval 0.39 - 1.25; P = 0.51). Prophylactic intramuscular diclofenac had no beneficial preventive effect on PEP.Clinicaltrials.gov NCT01717599.

Nicolau syndrome in a female patient following administration of intramuscular diclofenac injection: A case presentation

Introduction: Nicolau syndrome is a rare condition involving tissue necrosis as an adverse reaction to intramuscular preparations.The aim of this paper is to provide an understanding of Nicolau syndrome and its management. Methods: Design: A case study approach was adopted. Setting: The study took place in a rural health centre in Jamaica WestIndies. An audit of the client’s medical record and interview with the client to obtain a history of the condition, followed by acomprehensive physical examination and laboratory testing. Synthesis of clinical and laboratory data as well as comparison offindings of similar cases done to confirm diagnosis. Results: Findings illustrate severe tissue necrosis with residual effect following intramuscular injection of diclofenac. Conclusions: The client had extensive tissue necrosis after receiving diclofenac injection which could be minimized with correctinjection technique and early management of adverse reaction. This study provides valuable insight into the need for registerednurses, clinical nurse specialists, advanced practice nurses and doctors, to be knowledgeable of injection techniques, recognitionof adverse effects of medications and the need for prompt specific management of adverse effects.

S053: A prospective randomized, comparative trial of the effectiveness of dermal scarification and intramuscular diclofenac sodium injection in the treatment of renal colic

S053: A prospective randomized, comparative trial of the effectiveness of dermal scarification and intramuscular diclofenac sodium injection in the treatment of renal colic

Intramuscular diclofenac for the prevention of post-ERCP pancreatitis: A randomized trial

Intramuscular diclofenac for the prevention of post-ERCP pancreatitis: A randomized trial

Effects of diclofenac sodium on rat hippocampus exposed to acute unilateral subdural hematoma: A histological, stereological and molecular study

In this study, it was aimed to evaluate the potential effects of acute subdural hematoma (ASDH) and diclofenac sodium therapy following ASDH on the rat hippocampus by histological, stereological and biochemical methods. For this aim, 24 male Sprague-dawley rats were used. The subjects were divided into 4 groups. One ml venous blood was collected from the tail vein of the all animals before seven day from experimental acute subdural hematoma. Plasma serotonin, adrenaline and noradrenaline levels were measured in these plasma samples. During experimental acute subdural hematoma: Non-heparinized 0.1 ml of autologous blood from the tail vein of the animals in Group 3 and 4 were given to subdural space. Group 4 daily received intra-muscular diclofenac sodium administration at 15-mg/kg-dose from the postoperative second hour to 7 th day of the operation. Group 1 and 2 used for control and sham operation, respectively. At postoperative 8 th day, 1 ml venous blood from the all animals was collected before perfusion. The brain of animals were analysed by histological, stereological and biochemical techniques. The mean number of neurons in the CA1, CA2, CA3 regions of the hippocampus was estimated. Total number of neurons in the hippocampus of the diclofenac sodium treated group was significantly decreased. When comparing of postoperative blood samples, there was no difference between the levels of adrenaline and serotonin levels among the groups. But, only noradrenalin levels in the treated group it found to be higher than those of the sham and control groups (p<0.05). In this study, it was shown that using of diclofenac sodium after acute subdural hematoma caused to loss of the neurons in the hippocampal CA1, CA2, and CA3 regions.

Dermal scarification versus intramuscular diclofenac sodium injection for the treatment of renal colic: a prospective randomized clinical trial.

The aim of the study is to determine whether dermal scarification is equally effective for treating acute renal colic compared to diclofenac sodium intramuscular therapy. A prospective, randomized controlled study was conducted with methodologic rigor based on CONSORT criteria. A total of 291 patients, aged ≥ 18 years, suffering from acute renal colic were included in this trial and randomly assigned in two groups. Patients in the first group (A) received endodermal injection (dermal scarification) of 1 ml normal saline at the area of intensity of pain. The second group (B) received 75 mg diclofenac sodium by intramuscular injection. The success of each method defined the primary end point. Pain intensity before and after treatment was assessed using a visual analog scale. The time onset and the duration of analgesia were also recorded. There was no significant difference between the two groups regarding hematuria (p = 0.158), stone identification at KUB (p = 0.751) and mean pain intensity (p = 0.609) before treatment initiation. The method was successful in 75.5 % of patients in group A and 74.3 % of patients in group B (p = 0.812). Mean pain reduction was comparable, 5.65 ± 3.05 in group A and 5.34 ± 2.99 in group B (p = 0.379), with dermal scarification eliciting its effect considerably faster, whereas the duration of analgesia was longer in the diclofenac group (p < 0.05). In conclusion, dermal scarification could constitute an alternative method for treating renal colic as it is equally effective compared to the standard treatment of diclofenac sodium.

A Survey of the Pain Management of Acute Painful Crisis among Patients with Sickle Cell Disease at Two Centres in Jamaica.

The aim of this survey was to establish the pain management approaches to acute painful crisis (APC) in sickle cell patients at two healthcare facilities and to compare with available guidelines. A multi-centre observational survey of the management of APC in sickle cell patients was conducted. Data were collected at the Sickle Cell Unit (SCU), Tropical Medicine Research Institute (TMRI) and Accident and Emergency Department (A&E), University Hospital of the West Indies. One hundred episodes of uncomplicated APC involving 81 patients managed at the SCU clinic and 64 episodes at the A&E in a total of 28 patients were included in the data set. Drugs used at the SCU included oral morphine, codeine and paracetamol and intramuscular diclofenac. At the A&E, parenteral morphine and pethidine were most commonly used. At the SCU, the mean time to initiation of analgesics was 38 minutes (IQR 25 to 50 minutes); at the A&E, this was 111 minutes (IQR 50 to 150 minutes). At the SCU, the mean duration of stay (DOS) was 2.9 hours (IQR 1.9 to 3.8 hours) with 94% of the patients being discharged home. At the A&E, the mean DOS was 13.0 hours (IQR 8.3 to 16.9 hours) with 93% of the patients being discharged home. The A&E patient group contained multiple high frequency presenters. Documentation of pain severity scores was inconsistent. The findings of the survey indicate that the management of APC at the two centres is substantially different. Further study is required to investigate patient satisfaction, centre preference and analgesic therapy efficacy.

Bupivacaine-soaked absorbable gelatin sponges in caesarean section wounds: effect on postoperative pain, analgesic requirement and haemodynamic profile

BackgroundPain is a common distressing adverse effect in the early postoperative period following caesarean section. The aim of this study was to investigate the effect on postoperative pain, analgesic requirement and haemodynamic profile of placing a suprafacial bupivacaine-soaked absorbable gelatin sponge in the caesarean section wound. MethodsA total of 164 healthy patients scheduled to undergo general anaesthesia for elective caesarean section were randomised to a study group (n=81) or a control group (n=83). In the study group, a bupivacaine-soaked absorbable gelatin sponge was placed subcutaneously in the caesarean section wound. Intramuscular diclofenac 75mg was given to all patients at 8-h intervals during the first 24h. Postoperatively, visual analogue scale pain scores, requirement for pethidine and diclofenac and changes in blood pressure and heart rate were compared between groups. ResultsPain scores were lower in the study group compared to the control group at all assessments (P<0.001). During the first eight hours after surgery, fewer patients in the study group required rescue pethidine compared with the control group (4 vs. 33, P<0.001). In the study group, total opioid and diclofenac consumption was lower (P<0.001), and blood pressure and heart rate were lower (P<0.001) compared to the control group. ConclusionSuprafascial wound placement of a bupivacaine-soaked absorbable gelatin sponge improved postoperative analgesia and decreased opioid consumption following caesarean section.

Is endoscopic biliary sphincterotomy helpful for prevention of post-ERCP pancreatitis for SEMS insertion for malignant biliary obstruction?

s / Pancreatology 14 (2014) S1eS129 S23 the diclofenac group. After univariate analysis, PEP was significantly associated with male sex, pancreatic sphincterotomy, papillectomy and pancreatic stenting. Furthermore, adjusting for confounding factors through multivariate analysis revealed PEP was significantly associated with only male sex and endoscopic papillary balloon dilatation. Contrary to previous results, univariate and multivariate analyses failed to show that intramuscular diclofenac prevented PEP (OR 1⁄4 0.915, 95% CI 1⁄4 0.480e1.747, P 1⁄4 0.788; OR 1⁄4 0.790, 95% CI 1⁄4 0.391e1.252, P 1⁄4 0.511, respectively). Conclusion: Prophylactic intramuscular diclofenac had no beneficial effect on the prevention of PEP.

The effect in the prevention of post-ERCP pancreatitis as a 8-hour or 24-hour infusion of Nafamostat mesilate is same?: A prospective comparison study

s / Pancreatology 14 (2014) S1eS129 S23 the diclofenac group. After univariate analysis, PEP was significantly associated with male sex, pancreatic sphincterotomy, papillectomy and pancreatic stenting. Furthermore, adjusting for confounding factors through multivariate analysis revealed PEP was significantly associated with only male sex and endoscopic papillary balloon dilatation. Contrary to previous results, univariate and multivariate analyses failed to show that intramuscular diclofenac prevented PEP (OR 1⁄4 0.915, 95% CI 1⁄4 0.480e1.747, P 1⁄4 0.788; OR 1⁄4 0.790, 95% CI 1⁄4 0.391e1.252, P 1⁄4 0.511, respectively). Conclusion: Prophylactic intramuscular diclofenac had no beneficial effect on the prevention of PEP.

Intramuscular diclofenac for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A randomized, double-blind, placebo-controlled trial

Intramuscular diclofenac for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A randomized, double-blind, placebo-controlled trial

Sa1799 Intramuscular Diclofenac for the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Randomized, Double-Blind, Placebo-Controlled Trial

Sa1799 Intramuscular Diclofenac for the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Randomized, Double-Blind, Placebo-Controlled Trial

Diclofenac vs. Placebo in a Randomized Double Blind Controlled Trial, in Post ERCP Pancreatitis

<b>Background and Study Aim:</b> In several studies non-steroidal anti inflammatory drugs (NSAIDs) showed reduction of post (ERCP) pancreatitis incidence and severity. Our aim is to study the effect of NSAIDs in reducing post ERCP pancreatitis (PEP). <b>Patients and Methods:</b> A double blind placebo controlled study was conducted, patients who underwent ERCP in Specialized Arab Hospital (SAH), collected over one year, from June 2012 to June 2013 . Patients were randomized by an endoscopy nurse to receive IM Diclofenac 75 mg, or IM isotonic saline 3 ml as placebo. 12 hours after completing the procedure all patients were evaluated for abdominal pain and serum amylase. <b>Results: </b>The total number of patients was 199 patients, 17 patients were excluded, 182 patients completed the study, diclofenac group (89), placebo (93), the two groups were comparable for the following: age, sex, ERCP finding, pancreatic duct cannulation, failure of common bile duct (CBD) cannulation, number of pancreatic duct cannulation, ERCP time, sphincterotomy, and stenting. The overall incidence of pancreatitis was (18/182) 10%, (6/89) 6.9% for the diclofenac group and (12/93) 12.9% for the placebo group. There was no significant difference in the incidence of pancreatitis between the two groups; the P value was 0.164. In all the cases in which pancreatitis occurs, it was mild or moderate; there was no severe pancreatitis among the two groups. But in subgroup analysis the frequency of pancreatitis in patients with multiple pancreatic duct cannulation was significantly lower in the diclofenac group than in control group with p value = 0.021. <b>Conclusion</b>: Intramuscular diclofenac does not lower PEP rate or severity. But it significantly decreased PEP in patients with multiple pancreatic duct cannulations.

Low prevalence of hypersensitivity to nonsteroidal anti-inflammatory drugs in Chinese patients with chronic rhinosinusitis

The exact prevalence of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) remains unclear in patients with chronic rhinosinusitis (CRS) because many of these patients routinely avoid the use of NSAIDs. Since the diagnosis of aspirin hypersensitivity is based mainly on history, the aspirin challenge protocol is seldom used clinically in China. The objective of this study is to investigate the prevalence of NSAID hypersensitivity in Chinese patients diagnosed with CRS. In a unique cohort study, consecutive CRS patients received intramuscular diclofenac sodium injection or diclofenac sodium sustained-release tablets to relieve intraoperative and postoperative pain following nasal surgery. In addition, data on NSAID hypersensitivity in large-sample series of CRS patients were collected by searching relevant literature published in Chinese to determine the prevalence of NSAID hypersensitivity in Chinese patients with CRS. A total of 244 consecutive CRS patients were included in this study. Three (1.34%) patients experienced a severe asthmatic attack after intramuscular diclofenac sodium injection and were diagnosed with NSAID hypersensitivity. Despite the use of different methods to diagnose NSAID hypersensitivity, the prevalence of NSAID hypersensitivity in Chinese CRS patients was between 0.28 and 1.46%. The prevalence of NSAID hypersensitivity in Chinese patients with CRS is low, which is a distinct clinical characteristic of Chinese CRS patients. Despite the apparently low prevalence of the condition in this population, a large number of patients in China are affected by this disorder, which should not be overlooked or regarded with an indifferent attitude in medical research and clinical practices.

Antipyretics in the emergency department - intravenous paracetamol versus intramuscular diclofenac: a comparative study

Fever is a common problem in adults visiting the emergency department (ED) [1]. Although it is important to treat the cause of fever, symptomatic management of fever is also necessary. Multiple studies are available on the efficacy of various antipyretics in children, but very little has been done in adults [1],[2]. Hence we aimed to compare the antipyretic efficacy of intravenous (i.v.) paracetamol and intramuscular (i.m.) diclofenac in adult patients presenting with fever to the ED.

Thoracic paravertebral block for analgesia after modified radical mastectomy

Background: Surgical intervention is associated with postoperative pain, nausea and vomiting. Paravertebral blockade (PVB) has been advocated as a useful technique for analgesia after breast surgery. Aims and Objectives: The aim is to study the efficacy of PVB and associated complications against intramuscular diclofenac sodium 0.75mg. Materials and Methods: Fifty patients of ASA grade I and II were randomized to receive either PVB (group A) or intramuscular diclofenac sodium (group B); there were 25 patients in each group. Group A patients received PVB with catheter at T3 and T6 levels with 0.3ml/kg 0.25% bupivacaine, whereas group B patients received intramuscular diclofenac sodium preoperatively. All patients were observed for quality and duration of analgesia, incidence of nausea and vomiting, hemodynamic stability, and complication. Results: The patients given PVB experienced lower visual analog score (VAS) at rest (P < 0.001) and longer duration of analgesia (P < 0.001) on movement (P < 0.0001) for 1 to 12 h in postoperative period as compared to group B. In group A, fewer patients required rescue analgesia and experienced less postoperative nausea and vomiting as compared to group B. Conclusion: PVB provides better pain control and decreased nausea and vomiting after modified radical mastectomy.

The comparison of analgesic effects of Transdermal, Oral and Intramuscular Diclofenac Sodium in Early Postoperative Period in Laparoscopic Cholecystectomy Operations;The efficacy of various administration methods of Diclofenac Sodium in post-operative

Objective: The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. Methods: Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete’s Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded. Results: Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. Conclusion: In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment.

The Efficacy of Bupivacaine Infiltration on the Nephrostomy Tract in Tubeless and Standard Percutaneous Nephrolithotomy: A Prospective, Randomized, Multicenter Study

To assess the analgesic efficacy of bupivacaine infiltrations into the nephrostomy tract in tubeless and standard percutaneous nephrolithotomy (PCNL). This prospective, randomized controlled study enrolled 121 patients. Patients were randomized to receive a 20-mL infiltration of 0.25% bupivacaine into the nephrostomy tract after PCNL. Patients were divided into 2 groups. The group 1 patients received bupivacaine infiltrations, whereas group 2 did not. Patients' visual analog scale (VAS) pain scores were evaluated at 6, 12, and 24 hours postoperatively. Pain in the postoperative period was managed with intramuscular diclofenac sodium (75 mg) or meperidine (pethidine) hydrochloride (50 mg), as requested by the patients. The patients were a mean age of 43.2 ± 12.7 years (range, 18-74 years). The VAS pain scores at 6, 12, and 24 hours postoperatively and the amount of diclofenac sodium needed were significantly less in the group with bupivacaine infiltration than in those that did not receive the infiltration (P<.05). The VAS pain scores in patients with tubeless PCNL were significantly lower than those in patients with standard PCNL (P<.05). The pain after tubeless and standard PCNL may be decreased by bupivacaine infiltration into the nephrostomy tract. The findings of the present study reveal that a tubeless procedure and local analgesic infiltration into the nephrostomy tract after the PCNL is the more comfortable procedure for the patients.

English

BACKGROUND: The search for an ideal drug for postoperative analgesia is ongoing. Diclofenac is commonly used drug for this purpose in different routes. AIMS: To compare the efficacy of transdermal diclofenac with intramuscular diclofenac for postoperative analgesia. SETTINGS AND DESIGN: This prospective comparative study was conducted in the department of anaesthesiology in a medical college & general hospital. METHODS AND MATERIALS: The study subjects were 200 patients of both sexes between 18-50 years of age who were scheduled for elective laparoscopic, gynaecological & orthopaedic surgeries on limb. They divided into two groups. Group I received intramuscular injection of diclofenac sodium (75mg) & Group II received transdermal diclofenac diethylamine patch (200mg per 75 sq.cm) postoperatively. The outcome measures were pain intesity, changes in vital parameters, requirment for rescue analgesia & adverse effects. STATISTICAL ANALYSIS: Parametric data were analysed by using student t-test (unpaired). Non parametric data were analysed by using test of association (chi-square test). RESULTS: The mean pain score was significantly high in intramuscular diclofenac group (Group I) in laparoscopic & gynaecological surgeries (P = 0.002). Though the mean pain score was different among two groups in orthopaedic surgeries it was not statistically significant (P = 0.377). There were no significant differences in vital parameters & adverse reactions in between two groups. The requirment of rescue anlgesia was significantly more in intramuscular diclofenac group (Group I). CONCLUSIONS: Transdermal diclofenac is more effective in reducing the intensity of postoperative pain following laparoscopic & gynaecological surgeries but the effect is similar to intramuscular

Diclofenac Mediated Demodulation of Alkaline Phosphatase and Renal Cortical Damage in Experimental Albino Mice

Diclofenac sodium is known to interfere with renal physiology by inhibiting prostaglandins. Previous studies indicate that various nephrotoxins damage proximal renal tubules by altering alkaline phosphatase (APase) activity. APase has been reported to be a function related marker in renal proximal tubular epithelia where it is highly expressed. Present investigation deals with toxicity caused in mice kidney at histological and biochemical levels after diclofenac administration. Diclofenac toxicity was assessed by localizing APase in kidney histochemically and biochemically. Intramuscular diclofenac administration (10 mg/kg/body wt) for 30 days exhibited substantial degeneration in kidney. A marked change in APase activity was observed in histochemical and biochemical studies. A change was noticed in specific activity of APase at different periods of diclofenac treatment. Decrease in specific activity of APase after 10 days (18.41 %) and 30 days (55.3 %) of diclofenac exposure was observed. However, an insignificant hike in APase was observed after 20 days of drug therapy. Similar trends in APase activity were evidenced by the electrophoretic analysis. Histological and ultrastructural observations also corroborated above mentioned findings. Present investigation gives an insight into probable mechanism of renal pathology caused by diclofenac administration in mice.