Intramuscular Injection Of Diclofenac Sodium Research Articles

Acupuncture for response and complete pain relief time of acute renal colic: Secondary analysis of a randomized controlled trial

BackgroundThe integration of acupuncture with intramuscular injection of diclofenac sodium can expedite the onset of analgesia in treating acute renal colic caused by urolithiasis. However, it remains unclear whether acupuncture can accelerate pain relief constantly until complete remission. This study aimed to explore the extent to which acupuncture can expedite the onset time of response or complete pain relief in treating acute renal colic, and the predictive value of patient characteristics for treatment efficacy. MethodsThis secondary analysis utilized data from a prior randomized controlled trial. Eighty patients with acute renal colic were randomly assigned 1:1 to the acupuncture group or the sham acupuncture group. After intramuscular injection of diclofenac sodium, acupuncture or sham acupuncture was delivered to patients. The outcomes included time to response (at least a 50 % reduction in pain) and complete pain relief. Between-group comparison under the 2 events was estimated by Kaplan-Meier methodology. Subgroup analysis was performed utilizing the Cox proportional hazards model. ResultsThe median response time and complete pain relief time in the acupuncture group were lower than those in the sham acupuncture group (5 vs 30 min, Log Rank P < 0.001; 20 min vs not observed, Log Rank P < 0.001, respectively). Hazard Ratios (HRs) for response across all subgroups favored the acupuncture group. All HRs for complete pain relief favored acupuncture, expect large stone and moderate pain at baseline. No interaction was found in either event. ConclusionAcupuncture can accelerate the response time and complete pain relief time for patients with acute renal colic, with the efficacy universally. Trial registrationThis study has been registered at Chinese Clinical Trial Registry: ChiCTR1900025202.

A Combined approach of surgery and negative pressure wound therapy in post intramuscular injection necrotizing fasciitis: A case report

Necrotizing fasciitis is one of the most severe soft tissue infections, having substantial fatality rates even in facilities with the highest standards. Typically, it first affects the muscular fascia before spreading to the muscles and subcutaneous tissues. Thus, the therapy for this illness depends on early detection. In this report, we present the case of an 18-year-old male who developed severe necrotizing fasciitis in the right gluteal area following an intramuscular injection of diclofenac sodium. The patient received significant surgical debridement, negative pressure wound therapy (NPWT), and antibiotics as part of their care. A split-thickness skin graft was used for reconstruction. Our results were outstanding as the wound totally healed. Overall, our findings portrayed the importance of taking serious action against soft tissue infections.

Nicolau’s syndrome following intramuscular administration of Diclofenac sodium

Nicolau’s syndrome, also known as embolia cutis medicamentosa or livedo-like dermatitis, is an uncommon rare cutaneous adverse reaction occurring at the site of intramuscular, intra-articular, or rarely subcutaneous injection of particular drugs, leading to necrosis of skin and underlying tissues. We, hereby, report two fatal cases of this syndrome after taking intramuscular injection of diclofenac sodium.

The Anti-Rheumatoid Activity of Niclosamide in Collagen-Induced Arthritis in Rats.

This study aims to evaluate the anti-arthritic effect of orally administered niclosamide (NCL) on collagen-induced arthritis (CIA) in rats. The study included 35 Sprague Dawley rats (age range, 3 to 4 months; average weight, 100±10 g) of which seven were used as a negative control group (group A) whereas 28, in which arthritis was induced by injection of collagen type II emulsified by incomplete Freund's adjuvant and which were considered as CIA rats, were randomly divided equally into four groups and treated for 28 days with: normal saline (group B), low-dose NCL (group C), high-dose NCL (group D), and diclofenac sodium (group E). Body weight, arthritis index, ankle swelling, and footpad thickness were monitored before and after treatment in all groups. At the end of the treatment period, serum levels of tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and IL-6 were measured together with a collection of articular synovial tissue to evaluate the pathological changes. After four weeks of treatment period, a high dose of orally administered NCL significantly reduced the arthritis index, footpad thickness, and ankle swelling. Significantly decreased serum levels of inflammatory biomarkers including TNF-α, IL-1β, and IL-6 were observed in rats treated with high-dose oral NCL or intramuscular injection of diclofenac sodium, compared with groups B and C. Histopathological examination revealed that a high dose of NCL significantly reduced the infiltration of inflammatory cells, synovial hyperplasia, and bone and cartilage destruction. Niclosamide can effectively decrease the clinical scores, joint swelling, inflammatory markers, and pathological changes in arthritic rats.

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

Effect of cold needle on perception of pain during Intra Muscular Injection

The main aim of the study was to determine the effect of cold needle on perception of pain during intramuscular (IM) injection among adults in a selected hospital, Kerala. The objectives of the study were to assess the level of pain during intramuscular injection with the needle at room temperature, to assess the level of pain during intramuscular injection with cold needle at 0–2 degree Celsius, to compare the level of pain during Intramuscular injection with needle at room temperature and cold needle at 0–2 degree Celsius, and to determine the association between the level of pain and selected baseline variables. An evaluative approach was used with a quasi experimental one group pretest post test design. The study was conducted among adults (21–60 years) those who received IM injection of Diclofenac sodium. Using non probability purposive sampling technique 50 adults were selected. Each adult received IM injection (2 doses) with needle at room temperature and cold needle (0–2 degree Celsius) alternatively. Study findings revealed that the mean pain score 5.32 with needle at room temperature was found significantly higher than the mean pain score (2.00) with cold needle. There was a significant association found between the level of pain perception and previous experience to IM injection with cold needle. Thus it was concluded that cold needle (0–2 degree Celsius) is effective in reducing the perception of pain during IM injection.

Difficult laparoscopic cholecystectomy and postoperative requirement of analgesics: An observational study

Context: Despite many advances in laparoscopic cholecystectomy (LC), postoperative pain is still a problem. Difficult and prolonged procedures may cause more postoperative pain. Operative difficulty scores in LC and their correlation with the postoperative visual analog scale (VAS) pain scores and postoperative analgesic requirements in these patients have not been studied before. Aim: The aim of this study is to evaluate the requirement of postoperative analgesics in patients with different grades of intraoperative difficulties in elective LC. Settings and Designs: This was an observational study conducted at two peripheral hospitals in Kashmir. Materials and Methods: A total of 322 patients were scheduled for LC. Nassar scale (grades 1–5) was used to grade the operative difficulty. Postoperatively, intramuscular injection of diclofenac sodium 50 mg BD was used for analgesia. The data recorded were duration of surgery, postoperative VAS score (0–10), and requirement of additional postoperative rescue analgesic with reference to Nassar scale. Statistical Analysis: Chi-square test/one-way ANOVA was used as a test of significance. Results: Sixteen patients required conversion to open cholecystectomy and were excluded from the study. The final study group comprised of a total of 306 patients (112 males and 194 females). The age of the patients ranged between 16 and 60 years with a body mass index of Conclusions: With increasing level of difficulty in LC, there is increased postoperative pain and requirement for additional analgesia.

Reconstruction of gluteal defects related to Nicolau Syndrome secondary to intramuscular injection of diclofenac sodium with negative pressure wound therapy followed by skin graft.

Objective: Nicolau syndrome, synonymously livedo-like dermatitis or embolia cutis medicamentosa is a rare complication of drug injection leading to locoregional necrosis of the skin, adipose and muscular tissue. Underlying physiopathology is not well unserstood and there is no standart guideline for its management. However, after the demarcation of necrosis, debridement and for large wounds reconstruction is mandatory. Even though vast majority of the Nicolau syndrome cases were reported by other disciplines but the plastic surgery, there may be further need for reconstructive procedures for wound closure. Material and Methods: Present study included eight patients admitted to our wound care center for necrosis at the gluteal region after intramuscular injection of diclofenac sodium who were treated with debridement, negative pressure wound therapy and skin grafts. Patients’ ages, genders, body mass indexes, underlying diseases were documented. Sizes of the lesions were measured. Injection, hospitalization, skin graft operation and discharge dates were recorded. Results: All the wounds healed uneventfully but with depressed scars. Mean duration of hospitalization was 23.5 (range, 15-34) days. Conclusion: In the present article, we reported that even if the hospitalization time is longer and cosmetic result is poorer, skin grafting after sufficient times of vacuum assited wound therapy administration is a reliable method. We do not recommend this method as the first choice but if there is not adequate adjacent soft tissue for harvesting flaps or if a suitable perforator vessel is not found for peforator flap harvest, this reliable method should be kept in mind.

A Study on Effectiveness of Ilioinguinal and Iliohypogastricnerve Block at the Time of Wound Closure for Postoperative Pain Relief in Inguinal Hernia Repair

This study was to evaluate the effect of an ilioinguinal-iliohypogastric nerve block with bupivacaine 0.25% on the postoperative analgesia and subsequent analgesic requirements in patients undergoing unilateral open inguinal herniorrhaphy under spinal anaesthesia. Fifty consenting American society of anaesthesiologists (ASA) score I-II patients scheduled for unilateral inguinal herniorrhaphy procedures were given spinal anaesthesia with hyperbaric 0.5% bupivacaine. In a randomized fashion, half of them received an ilioinguinal-iliohypogastric nerve block (IINB) with 30 millilitre (ml) of 0.25% bupivacaine at the time of wound closure and then other half with intramuscular injection of diclofenac sodium 75 milligram (mg). The patients were observed for postoperative 24 hour, such as duration of postoperative analgesia, first on demand analgesic and total analgesic doses, 4 hourly visual analogue scales (VAS), complications of nerve block, 4 hourly haemodynamic changes and assessed patient’s satisfaction at postoperative 12 hour in both groups. The results showed that in comparison with diclofenac group (group B), significantly longer duration of postoperative analgesia in IINB group (group A) (P<0.05%) and the amount required was also significantly less postoperatively in 24 hour (P<0.05%). No complications occurred. Patient’s satisfaction score at postoperative 12 hour was higher in group (A) patients (P<0.05%). There was no significant difference in haemodynamic changes between the two groups. It is concluded that the use of IINB with bupivacaine 0.25% at the time of wound closure in patients undergoing unilateral open inguinal herniorrhaphy under spinal anaesthesia decreased pain and analgesic requirements in the postoperative 24 hour and increased patient’s satisfaction score at postoperative 12 hour.

The Use of ShotBlocker for Reducing the Pain and Anxiety Associated With Intramuscular Injection: A Randomized, Placebo Controlled Study.

There are few studies evaluating the effect of ShotBlocker on pain acquired from intramuscular injection, and these are mostly in children. We hypothesized that the use of ShotBlocker, while administering an intramuscular injection, would reduce the pain and anxiety due to intramuscular injection in adults. A randomized, placebo controlled trial was carried out for more than 20 months in 2010-2011 on 180 adults aged 18 to 80 years who received intramuscular injections of diclofenac sodium (75 mg/3 mL) at the outpatient clinic of a hospital. The patients were grouped into 3 groups: control, placebo control, and experimental. The experimental group was given an intramuscular injection of diclofenac sodium with ShotBlocker. Pain intensity was measured through a visual analog scale after the injection and anxiety was measured using Spielberger's State-Trait Anxiety Inventory. Pulse rate was counted and state and trait anxiety was measured before and after the injection. The Mann-Whitney U test and Wilcoxon and Kruskall-Wallis tests were used to evaluate the data. Patients in the ShotBlocker group had significantly lower pain intensity than those in the placebo and control groups. State anxiety level increased after the injection in the experimental group but did not change in the other 2 groups. ShotBlocker did not affect the pulse rate. Our results suggest that using ShotBlocker during intramuscular injection reduced patients' pain intensity because of injection but did not reduce anxiety levels. Thus, ShotBlocker is recommended as a pain-relieving tool during intramuscular injection in adults.

Single intramuscular injection of diclofenac sodium in febrile pediatric patients.

Objectives:There are few reports on the effectiveness and safety of intramuscular (IM) antipyretic injections in pediatric patients. This study reports the efficacy and adverse effects of a single IM injection of diclofenac sodium in pediatric patients.Materials and Methods:This was an observational study in which records of febrile pediatric patients presenting to the emergency department were analyzed. Subjects included pediatric patients presenting to the emergency department with a temperature of 38°C or higher. Infants under 12 months of age were excluded. Patients were excluded if they received antipyretics within 4 h prior to presenting to the emergency department. Body temperature was measured at 30–60 min intervals following diclofenac sodium injections. Fever alleviation was defined as the temperature decline to 1°C below the temperature at presentation. Patients who received diclofenac sodium twice or more on different days were observed for side effects such as allergic reaction. Records from the emergency department and outpatient clinics were analyzed.Results:The dose of diclofenac sodium injected was approximately 2 mg/kg. The average time elapsed until antipyresis was 69.1 ± 23.8 min. The average temperature reduction after 1 h was 1.1 ± 0.6°C. The average proportion of temperature change after 1 h was 40.6 ± 22.2%. During the period at the emergency department, there were no reported serious side effects.Conclusions:A single dose of diclofenac sodium provided effective antipyresis in pediatric patients. Serious side effects were not observed.

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

Sonographic findings in Nicolau syndrome following intramuscular diclofenac injection: A case report

Nicolau syndrome (also known as embolia cutis medicamentosa and livedoid dermatitis) is a rare but severe localized adverse drug reaction of intramuscular injection of various drugs. The typical presentation is pain around the injection site soon after injection, followed by erythema, livedoid patch, hemorrhagic patch, and finally necrosis of skin, subcutaneous fat, and muscle tissue. We report a case that occurred in a 34-year-old woman after intramuscular injection of diclofenac sodium. Sonography showed diffuse thickening with increased echogenicity of the skin and subcutaneous fat layer, while MRI revealed extensive edema involving gluteal and piriformis muscles and deep fascia, and fluid collection.

Pain Perception of Patients Predisposed to Anxiety and Depressive Disorders in Emergency Department

The aim of this study was to reveal the effects of anxiety and depression on pain perception in the emergency setting. This randomized prospective study was performed in an urban tertiary care hospital emergency department (ED). Consecutive patients presenting to the ED with pain who had an intramuscular injection of diclofenac sodium were enrolled in the study. The prevalence of anxiety and depressive disorders in study subjects was determined by using the Hospital Anxiety and Depression Scale. A total of 302 patients were included. Study subjects had a mean age of 41.3 ± 13.7 years and 35.4% (n = 107) were male. Pain perception in women was significantly higher than in men (median 8.5 vs. 5, respectively; p = .033). Pain perception in elderly patients, ≥65 years old, was found to be lower than in patients <65 years old (median 1 vs. 6.5, respectively; p = .02). Anxiety was found to be related to higher pain perception after adjusting for confounding variables (13.8 vs. 7.6, respectively; adjusted p = .022). Gender, age, and anxiety, but not depression, are possible factors related to pain perception in the emergency setting. Further studies are needed to reveal the factors affecting pain perception and the complex relationship between psychiatric status and pain.

Control of Pain during Transrectal Ultrasound-Guided Prostate Biopsy: A Prospective Study Comparing Two Methods

Aim: To evaluate the efficacy of intramuscular injection of 75 mg diclofenac sodium and periprostatic nerve block (PPNB) with 1% lignocaine in controlling pain during transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and Methods: A total of 120 patients undergoing TRUS-guided prostate biopsies were prospectively enrolled in the study. First, 20 patients did not get any form of analgesia/anesthesia and served as control; next, 20 patients received an intramuscular injection of diclofenac sodium. PPNB with 1% lignocaine was performed in the remaining 80 patients. Pain was assessed using Wong-Baker Faces Pain-Rating Scale (0–10). Results: All three groups of patients were comparable at baseline in terms of age, prostate-specific antigen and final histological diagnosis. The mean pain scores (±SD) for control, diclofenac and PPNB groups were 5.10 ± 3.14, 3.70 ± 2.36 and 2.24 ± 1.63, respectively. The difference was statistically significant between control and PPNB (p = 0.001), and diclofenac and PPNB (p = 0.002), but not between the control and diclofenac group (p = 0.120). In addition, the proportion of patients having mild or no pain (defined as pain score ≤3) during the biopsy was greater in the PPNB group (71%) compared with the diclofenac group (45%) and the control group (30%) (p = 0.001). The total duration for TRUS biopsy was not significantly different between the three groups (p = 0.114). Conclusion: PPNB with 1% lignocaine significantly decreases pain associated with prostate biopsy when compared with control and intramuscular diclofenac.

Low-Volume Interscalene Brachial Plexus Block for Post-Thoracotomy Shoulder Pain

This study was designed to evaluate the effectiveness of low-volume interscalene brachial plexus block for post-thoracotomy ipsilateral shoulder pain and to compare it with nonsteroidal anti-inflammatory drug treatment. Prospective nonblinded study. University hospital. Sixty adult patients. Patients who underwent elective thoracic surgery under combined epidural and general anesthesia, and after surgery were free of incisional pain but complaining of shoulder pain, were included in the study. They were selected in a sequential manner and placed into 2 groups of 30 patients each. Group 1 had a low-volume interscalene brachial plexus block, using 10 mL of bupivacaine 0.5%. Group 2 had an intramuscular injection of diclofenac sodium, 75 mg. Pain was measured during their stay in the postanesthesia care unit (PACU) by using a visual analog score (VAS). Opioids were administered when pain relief was incomplete. Pain intensity was re-estimated the next morning and patient satisfaction was scored. VAS was found to be significantly lower in the low-volume interscalene block group than in the diclofenac group at 30 minutes after treatment and when leaving PACU (p < 0.001 for both). Patients in the interscalene block group stayed longer in the PACU (p = 0.019), and significantly fewer required rescue opioids (p = 0.03). There was no significant difference between the groups in patient satisfaction with the pain treatment. The authors concluded that low-volume interscalene brachial plexus block is a superior treatment for post-thoracotomy shoulder pain compared with diclofenac injection, although it requires a slightly longer stay in the PACU.