Rectal Diclofenac Research Articles

Rectal Diclofenac Versus Oral Diclofenac in the Management of Pain after Episiotomy Repair: A Randomised Controlled Trial at LAUTECH (now UNIOSUN) Teaching Hospital, Osogbo, Osun State, Nigeria

Background Safe and effective analgesia following episiotomy repair reduces postpartum morbidity. Oral diclofenac has proven to be of benefit in pain control, however, there is a need for an alternative route with the same analgesic efficacy because of the common significant side effects on the gastrointestinal tract. Hence, this study compared the effectiveness of rectal diclofenac to oral diclofenac in the management of pain after episiotomy repair at LAUTECH Teaching Hospital, Osogbo. Methods A randomised trial was carried out among parturients that had vaginal delivery and episiotomy repair from May to October 2020. 82 parturients (41 in each arm) were randomised to either 50mg oral or 50mg rectal diclofenac 12hourly for 24 hours after episiotomy repair. Pain score and level of maternal satisfaction were assessed, degree of side effects was also measured. Chi-square and Student t-test were used to identify association. Results There was no significant difference between the randomised groups in any socio-demographic characteristics. Rectal diclofenac group had a lower pain score (Rectal, Mean + SD 3.15+1.35 versus Oral, 6.46 + 2.85 p-value <0.0001), less need for additional analgesia (36.6% oral versus 7.3% of rectal, p-value =0.001) and improved level of maternal satisfaction compared to oral route (68.3% in rectal versus 2.4% in oral). Conclusions Irrespective of any socio-demographic characteristics, rectal diclofenac is more effective, has a high degree of acceptability and maternal satisfaction than oral diclofenac following episiotomy repair.

Incidence of Post-ERCP Pancreatitis in Patients Receiving Rectal Indomethacin vs. Compounded Rectal Diclofenac Prophylaxis.

Endoscopic retrograde cholangiopancreatography (ERCP) carries a 3-15% risk of post-ERCP pancreatitis (PEP). Rectal indomethacin reduces the risk of PEP, but its cost has increased more than 20-fold over the past decade. Rectal diclofenac is also used to prevent PEP but is not commercially available in the United States. The aim of this study is to compare the incidence of PEP after administration of commercially available rectal indomethacin versus compounded rectal diclofenac and assess financial implications. ERCP cases at our institution with administration of 100mg rectal indomethacin or 100mg compounded rectal diclofenac between May 2018 and January 2022 were retrospectively reviewed. The incidence and severity of PEP was compared between the indomethacin (n = 728) and diclofenac (n = 304) groups. Risk factors (young age, female sex, history of pancreatitis or PEP, sphincterotomy during procedure, pancreatic indication, trainee involvement) and protective factors (prior sphincterotomy, pancreatic duct stenting) for PEP were compared between groups. 60 patients (8.2%) in the rectal indomethacin group and 25 patients (8.2%) in the compounded rectal diclofenac group developed PEP, resulting in moderate or severe PEP in 9 (15.0%) and 2 (8.0%) patients, respectively. The compounded rectal diclofenac group had more trainee involvement (46.1% vs. 32.8%, p = 0.0001) and more prior sphincterotomy cases (15.8% vs. 10.6%, p = 0.0193) compared to the rectal indomethacin group; no statistically significant differences were observed in all other risk and protective factors. Following switch to compounded rectal diclofenac, institutional annual cost savings amounted to $441,460.62 and patient charge decreased 45-fold. This retrospective single-center real-world analysis showed similar efficacy of rectal indomethacin and compounded rectal diclofenac in preventing PEP but demonstrates substantial cost savings after switching to compounded rectal diclofenac.

Efficacy of Diclofenac and Indomethacin for Prevention of Post-Endoscopic Cholangiopancreatography (ERCP) Pancreatitis: A Systematic Review.

Endoscopic cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic tool for pancreaticobiliary conditions. One of its major complications is pancreatitis. This study aims to understand the incidence of post-ERCP pancreatitis after using rectal diclofenac and Indomethacin as prophylactic measures. We retrieved 2870 articles from the PubMed, ScienceDirect, and Google Scholar databases. Using the Medical Subject Headings (MeSH) strategy in PubMed, we chose research articles published in the last five years. Exclusion criteria included paid full-text articles, abstracts, letters to editors, patients not undergoing ERCP, ages more than 45 years, animal studies, and non-English studies. The 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria were used in the design of our systematic reviews. It was found that the medical world is still debating whether rectal diclofenac and Indomethacin are beneficial in avoiding post-ERCP pancreatitis (PEP). Rectal diclofenac is used. Although its effectiveness is debated due to mixed findings and concerns about certain outcomes, it is also considered beneficial in specific circumstances, such as before ERCP. Studies on rectal Indomethacin also yield contradictory results; while some emphasize the drug's large reduction in PEP incidence, especially in low-risk people, others question its efficacy. We need further studies to clarify the remaining uncertainties.

Effect of Two Regimens of Rectal Diclofenac on Post Adenotonsillectomy Pain in Children

Effect of Two Regimens of Rectal Diclofenac on Post Adenotonsillectomy Pain in Children

Efficacy and safety of diclofenac suppository for postoperative pain relief after diagnostic hystero-laparoscopy and dye test: A double-blind, placebo-controlled, randomized trial

ObjectiveTo determine the efficacy and safety of rectal diclofenac for relieving postoperative pain following diagnostic hystero-laparoscopy and dye test (dHLD). MethodsA prospective, double-blind, placebo-controlled, randomized trial was conducted among women who underwent dHLD to evaluate fertility. The women received either rectal diclofenac with intramuscular pentazocine or intramuscular pentazocine with rectal placebo for postoperative analgesia. The median pain scores at different time points were assessed as the primary outcome measures using the Numerical Rating Scale for pain. The secondary outcome measures were analgesic consumption, time at which first analgesic was requested, satisfaction with pain relief and any adverse events. ResultsIn total, 108 participants were analysed (54 in each group, 1:1 ratio). The median score for postoperative pain was lower for the diclofenac group compared with the placebo group at 4 h (52.53 vs 56.47; p = 0.507), 6 h (50.48 vs 58.52; p = 0.174), 8 h (51.42 vs 57.65; p = 0.296), 10 h (51.35 vs 57.65; p = 0.285) and 12 h (52.45 vs 56.55; p = 0.485) post surgery, although the difference was not significant (p > 0.05). Seventeen participants required rescue analgesia with 30 mg of pentazocine: 11 at 4 h post surgery [5 (62.5 %) vs 6 (66.7 %)], three at 6 h post surgery [2 (25.0 %) vs 1 (11.1 %)], two at 8 h post surgery [1 (12.5 %) vs 1 (11.1 %)], and one at 12 h post surgery [0 vs 1 (11.1 %)] for the diclofenac and placebo groups respectively (p = 0.713). There were no significant differences in postoperative adverse effect profiles, overall patient satisfaction, and need for rescue analgesia between the two groups (p > 0.05). ConclusionsPostoperative use of rectal diclofenac and pentazocine is safe, but did not significantly improve pain scores, patient satisfaction and need for rescue analgesia following dHLD, compared with patients who received pentazocine and placebo. While a multi-modal approach to pain relief following dHLD does not appear to be significantly beneficial, a multi-centre study is needed to confirm or refute these findings.

Peculiarities of pharmacological prevention strategy of pancreatic complications after endoscopic papillosphincterotomy for choledocholithiasis

The most frequent complication of endoscopic papillosphincterotomy (EPST) is acute pancreatitis. This complication is supposed to be based on mechanical, chemical, hydrostatic, enzymatic and thermal impact on pancreatic ducts and parenchyma. According to different literature data, the incidence of post-EPST pancreatitis (PEP) varies from 30 to 40%, and the mortality rate is 2-10%. The aim of the investigation was to expand information about peculiarities of early diagnostics and prevention of post-EST pancreatitis at the present stage. To reach the set goal we analyzed 559 case histories of patients with diagnosed cholelithiasis, 319 of them underwent EPST. During the study it was found out, that elevated neutrophils/lymphocytes ratio over 4,96 (p=0,001), high LDH level over 250 IU/ml (p=0,01), as well as C-reactive to albumin index over 0,180 (p=0,001) are reliable markers of early diagnosis. Also, indirect diagnostic markers of PEEP are biochemical signs of cholestasis and cytolysis of hepatocytes, as well as hyperglycemia combined with glucosuria. We consider the inclusion of intraoperative injections of papillotomy wound margins with Epinephrine in combination with subsequent Somatostatin administration in combination with rectal Diclofenac and intravenous hydration with Reamberin to be the most effective strategy for PEP prevention. Thus, we can conclude that despite the ongoing research and the search for effective algorithms for the prevention and early diagnosis of PEP, their data often contradict each other or simply do not confirm their effectiveness. The problem of prevention and diagnosis of PEP remains complex and requires further study. There are discrepancies, sometimes significant ones, in the current literature, which provides grounds for the development and research of new methods of early diagnosis and prevention.

Effectiveness of Postoperative Analgesia with Rectal Placement of Diclofenac Sodium in Patients Undergoing Gynecological and Obstetrical Surgeries under General Anesthesia

Objective: To determine the frequency of need for postoperative intravenous analgesia after rectal diclofenac suppository in patients undergoing lower abdominal gynecological or obstetrical surgery under general anesthesiaStudy Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Operation Theater and Postoperative Ward of Sheikh Zayed Hospital, Lahore, Pakistan from January 2021 to July 2021.Methods: A total of 245 women undergoing gynecological and obstetrical surgeries under general anesthesia were enrolled in the study using non-probability consecutive sampling. All the participants were recruited after obtaining informed consent and meeting the inclusion criteria. All subjects had a single 100mg diclofenac suppository inserted rectally after undergoing general anesthesia, and their Visual Analog Scale (VAS) scores for postoperative analgesia were recorded immediately after surgery and again at 1, 6, and 24 hours.Results: The mean age of the patients was 37 years, with a standard deviation of 6.2. The mean VAS (Visual Analog Scale) scores at 1, 6, 12, and 24 hours were 3 (±1.24), 5 (±1.46), 7 (±1.93), and 6 (±2.14), respectively. The need for rescue analgesia was reported in 15.9% of cases at 1 hour, 37.1% at 6 hours, 82% at 12 hours, and 68.2% at 24 hours.Conclusion: The administration of diclofenac via rectal placement led to a notable decrease in Visual Analog Scale scores and a lower incidence of needing additional pain relief within the first 6 hours after surgery.
 How to cite this: Saeed R, Mahboob A, Ali SM, Latif A, Ammar T, Kakepotto IA. Requirement of Postoperative Analgesia after Per Rectal Placement of Diclofenac Sodium in Patients Undergoing Gynecological and Obstetrical Surgeries under General Anesthesia. Life and Science. 2024; 5(1): 120-125. doi: http://doi.org/10.37185/LnS.1.1.515

Adjuvant Rectal Diclofenac for Post Operative Analgesia after Caesarean Section—A Randomized Controlled Study

Adjuvant Rectal Diclofenac for Post Operative Analgesia after Caesarean Section—A Randomized Controlled Study

Randomized Comparative Study of Analgesic Effects of Ilioinguinal and Iliohypogastric Nerve Block with Levobupivacaine (0.25%) versus Diclofenac Suppository in Pediatric Patients Undergoing Inguinal Herniotomy under General Anesthesia

Context: Pain management intraoperatively and postoperatively in the pediatric age group is a matter of concern. On the one hand, children are poorer at precisely conveying the extent of pain all the while being more susceptible to pain-related complications such as laryngospasm. On the other hand, children are less suited to use of potent opioids due to associated complications which can often lead to catastrophe. Therefore, a multimodal approach is desirable to optimize pain management in children. A nerve block is a highly effective and popular modality nowadays. In this single-blinded, parallel group, monocentric, and randomized protocol study, we have compared the efficacy of pain control achieved in the use of nonsteroidal anti-inflammatory drugs as analgesic versus iliohypogastric ilioinguinal (IIIH) nerve block in herniotomy in pediatric age group. Materials and Method: The parallel-group prospective study recruited 104 participants who were randomly allocated into two groups of 52 each, such that both groups received 1 mcg/kg fentanyl and sevoflurane during induction of GA. For analgesia, Group 2 was given diclofenac suppository intraoperative after induction of GA. Group 1 was given IIIH nerve block under nerve stimulator guidance for perioperative analgesia. Both groups were studied for the following parameters which included: time to get the 1st dose of rescue analgesic, total dose of rescue analgesic, visual analog scale (VAS) score, and hemodynamic parameters. Results: We observed that Group 1 showed a statistically significant difference in the form of longer duration of analgesia after surgery (9.67 ± 1.80 h vs. 6.35 ± 0.84 h) and lower total dose of rescue analgesic requirement (69.23 ± 2 [22.77] vs. 106.23 ± 2 [21.49]) while having a better hemodynamic profile and lower cumulative VAS score (7.71 ± 1.39 vs. 12.04 ± 1.72). Conclusion: Based on the above findings, we deduce that preincisional nerve stimulator-guided IIIH block by levobupivacaine (0.25%, 0.3 ml/kg) and rectal diclofenac (2 mg/kg) is both safe approaches to provide postoperative analgesia in pediatric inguinal herniotomy under general anesthesia. However, nerve stimulator-guided IIIH nerve block by levobupivacaine is a safe and better choice as it provides more intense analgesia for a longer duration compared to diclofenac suppository in the immediate postoperative period.

A randomized controlled trial of rectal versus intramuscular diclofenac for post-operative analgesia after open myomectomy

AimTo determine the efficacy and safety of rectal versus intramuscularly administered Diclofenac in reducing post-operative pain in the first 24 h after open-myomectomy. MethodsA single blind, placebo controlled randomized trial consisting of 90 consenting women that had open-abdominal-myomectomy. They were randomized into two-groups (rectal-group and intramuscular-group) of 45 women (1:1 ratio). Rectal-group received 75 mg of Diclofenac suppository 12 hourly for 24 h and placebo (3 ml of intramuscular injection-water) 12hourly for 24 h while intramuscular-group received intramuscular Diclofenac 75 mg 12 hourly for 24 h and placebo (Anusol suppository) 12 hourly for 24 h. Both groups received intramuscular Pentazocine 30 mg 6 hourly for 24 h as primary analgesic after myomectomy. Pain was assessed using a Ten-Point Visual-Analogue-Scale. Participants’ satisfaction of the mode of the pain relief was assessed using the Likert-scale after 24 h. The primary outcome was the pain score using the visual-analogue-scale. The secondary outcome-measures were participants’ satisfaction after 24 h of administration of the drugs, the need and frequency of rescue-analgesia and maternal-side-effects. ResultThe baseline socio-demographic characteristics were similar in both groups. There was no statistically significant difference between both groups in pain assessment at 1 h post-myomectomy (p-value > 0.05). However, the pain assessments at 6, 12, 18 and 24 h post-myomectomy were statistically significant with more pain in intramuscular-group when compared to rectal-group. Majority of participants in rectal-group were both very satisfied (35.6 %) and satisfied (55.6 %) when compared to intramuscular-group (11.1 %) and (31,1%) respectively (p-value < 0.05). Also majority of the participants in intramuscular-group were dissatisfied (17.8 %) with none of the participant showing any form of dissatisfaction (p-value < 0.05). Majority of the participant in rectal-group had no drug side effects when compared with intramuscular-group. Epigastric discomfort was commoner in rectal-group while drowsiness was commoner in intramuscular-group. ConclusionRectal Diclofenac with intramuscular Pentazocine is significantly associated with better effectiveness in pain reduction and maternal satisfaction when compared with intramuscular Diclofenac and intramuscular Pentazocine following open-myomectomy. While epigastric discomfort was the commonest side-effect in rectal-group, drowsiness was commoner in intramuscular-group. Trial RegistrationPan-African-clinical-trial-registry (PACTR); PACTR202206556144219.

Peculiarities of pharmacological prevention strategy of pancreatic complications after endoscopic papillosphincterotomy for choledocholithiasis

The most frequent complication of endoscopic papillosphincterotomy (EPST) is acute pancreatitis. This complication is supposed to be based on mechanical, chemical, hydrostatic, enzymatic and thermal impact on pancreatic ducts and parenchyma. According to different literature data, the incidence of post-EPST pancreatitis (PEP) varies from 30 to 40%, and the mortality rate is 2–10%. The aim of the investigation was to expand information about peculiarities of early diagnostics and prevention of post-EST pancreatitis at the present stage. To reach the set goal we analyzed 559 case histories of patients with diagnosed cholelithiasis, 319 of them underwent EPST. During the study it was found out, that elevated neutrophils/ lymphocytes ratio over 4.96 (p = 0.001), high LDH level over 250 IU/ml (p = 0,010), as well as C-reactive to albumin index over 0,180 (p = 0.001) are reliable markers of early diagnosis. Also, indirect diagnostic markers of PEEP are biochemical signs of cholestasis and cytolysis of hepatocytes, as well as hyperglycemia combined with glucosuria. We consider the inclusion of intraoperative injections of papillotomy wound margins with epinephrine in combination with subsequent Somatostatin administration in combination with rectal diclofenac and intravenous hydration with Reamberin to be the most effective strategy for PEP prevention. Thus, we can conclude that despite the ongoing research and the search for effective algorithms for the prevention and early diagnosis of PEP, their data often contradict each other or simply do not confirm their effectiveness. The problem of prevention and diagnosis of PEP remains complex and requires further study. There are discrepancies, sometimes significant ones, in the current literature, which provides grounds for the development and research of new methods of early diagnosis and prevention.

NSAIDs do not reduce severity among post-ERCP pancreatitis patients

ObjectiveNon-steroidal anti-inflammatory drugs (NSAIDs) are the most studied chemoprophylaxis for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). While previous systematic reviews have shown NSAIDs reduce PEP, their impact on moderate to severe PEP (MSPEP) is unclear. We conducted a systematic review and meta-analysis to understand the impact of NSAIDs on MSPEP among patients who developed PEP. We later surveyed physicians’ understanding of that impact. DesignA systematic search for randomized trials using NSAIDs for PEP prevention was conducted. Pooled-prevalence and Odds-ratio of PEP, MSPEP were compared between treated vs. control groups. Analysis was performed using R software. Random-effects model was used for all variables. Physicians were surveyed via email before and after reviewing our results. Results7688 patients in 25 trials were included. PEP was significantly reduced to 0.598 (95%CI, 0.47–0.76) in the NSAIDs group. Overall burden of MSPEP was reduced among all patients undergoing ERCP: OR 0.59 (95%CI, 0.42–0.83). However, NSAIDs didn't affect the proportion of MSPEP among those who developed PEP (p = 0.658). Rectal Indomethacin and diclofenac reduced PEP but not MSPEP. Efficacy didn't vary by risk, timing of administration, or bias-risk. Survey revealed a change in the impression of the effect of NSAIDs on MSPEP after reviewing our results. ConclusionsRectal diclofenac or indomethacin before or after ERCP reduce the overall burden of MSPEP by reducing the pool of PEP from which it can arise. However, the proportion of MSPEP among patients who developed PEP is unaffected. Therefore, NSAIDs prevent initiation of PEP, but do not affect severity among those that develop PEP. Alternative modalities are needed to reduce MSPEP among patients who develop PEP.

Rectal versus Oral Diclofenac Sodium in Relieving Post-Episiotomy Pain: Randomized Controlled Study

Rectal versus Oral Diclofenac Sodium in Relieving Post-Episiotomy Pain: Randomized Controlled Study

Haematological Changes Following Intramuscular and Per- Rectal Diclofenac Sodium Administration in Dogs undergoing Orchiectomy

A total of 30 Nigerian indigenous male dogs aged 1-2 years (1.65±0.47) and 11-15kg (13.4±1.27) body weight were used for the study. They were randomly allocated into 6 groups of 5 dogs each. Groups A1, B1 and C1 for intramuscular at 2mg/kg, 3mg/kg and 4mg/kg respectively and Groups A2, B2 and C2 for per-rectal at 2mg//kg, 3mg/kg and 4mg/kg. Haematological values of Packed cell volume (PCV), haemoglobin (Hb), Red blood cell (RBC), White blood cell (WBC) and Differential leucocyte counts (DLC) of Lymphocyte (LYM), Neutrophils (NEU), Monocyte (MON) and Eosinophils (EOS) were determined. Statistical Package for Social Sciences Software Version 22.0 (SPSS Inc. Chicago. Illinois). General Linear Model (GLM) using repeated measures Analysis of Variance (RM-ANOVA), to compare the mean of different groups at a 95% confidence interval and a 5% level of significance was used. The PCV, Hb and Rbc values of the dogs castrated were within normal range when compared with specie corresponding values. The PCV value was lowest 38.6±1.9 at 2nd hour 2mg/kg for per rectum and highest of 44.1±1.9 at the 9th hour for per rectum at 4mg/kg dose. The Hb value was lowest at 12.9±0.5 at 1st hour for per rectum at 4mg/kg dose and the highest of 15.3±0.8 at 0 hour for intramuscular at 2mg/kg. The Rbc value was lowest at 4.0±1.5 at 4th hour, 2mg/kg for per rectum and the highest of 6.6±0.3 at 7th hour, 2mg/kg. The Total leucocyte count (TLC) values of WBC and DLC also recorded significant differences. There was significant difference (P&lt;0.05) between routes but values remain within normal range of values. This finding shows that the use of Diclofenac as a short term analgesic caused no significant changes on the haematocrit values of dogs when used after castration. This finding has also indicated that short-term use of diclofenac through the per rectum route may be safe and had no deleterious effect on haematological value of Nigerian indigenous male dogs

Methods of early diagnosis and pharmacological prevention of pancreatitis after endoscopic papillosphincterotomy

Introduction. The most frequent complication of endoscopic papillosphincterotomy (EPST) is acute pancreatitis. This complication is supposed to be based on mechanical, chemical, hydrostatic, enzymatic and thermal impact on pancreatic ducts and parenchyma. According to different literature data, the incidence of post-EPST pancreatitis (PEP) varies from 30 to 40 %, and the mortality rate is 2–10 %.The aim of the investigation was to expand information about peculiarities of early diagnostics and prevention of post-EST pancreatitis at the present stage.Materials and methods. To reach the set goal we analyzed 559 case histories of patients with diagnosed cholelithiasis, 319 of them underwent EPST.Results. During the study it was found out, that elevated neutrophils/lymphocytes ratio over 4,96 (p = 0,001), high LDH level over 250 IU/ml (p = 0,01), as well as Creactive to albumin index over 0,180 (p = 0,001) are reliable markers of early diagnosis. Also, indirect diagnostic markers of PEEP are biochemical signs of cholestasis and cytolysis of hepatocytes, as well as hyperglycemia combined with glucosuria. We consider the inclusion of intraoperative injections of papillotomy wound margins with Epinephrine in combination with subsequent Somatostatin administration in combination with rectal Diclofenac and intravenous hydration with Reamberin to be the most effective strategy for PEP prevention.Conclusions. Thus, we can conclude that despite the ongoing research and the search for effective algorithms for the prevention and early diagnosis of PEP, their data often contradict each other or simply do not confirm their effectiveness. The problem of prevention and diagnosis of PEP remains complex and requires further study. There are discrepancies, sometimes significant ones, in the current literature, which provides grounds for the development and research of new methods of early diagnosis and prevention.

Universal prophylactic rectal nonsteroidal anti-inflammatory drugs with a policy of selective pancreatic duct stenting significantly reduce post-endoscopic retrograde cholangiopancreatography pancreatitis.

Although rectal nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective for the prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis (PEP) in high-risk patients, the benefit in average-risk patients is unclear. We aimed at assessing the benefit of prophylactic rectal NSAIDs in unselected consecutive patients to prevent PEP. All patients undergoing index ERCP procedures from January 2018 until March 2020 were included. All patients received prophylactic rectal diclofenac. A prophylactic pancreatic duct (PD) stent was placed if there was repeated PD cannulation, at the discretion of the endoscopist. The frequency of PEP was compared with historical controls. Of 769 patients who underwent ERCP, 34 (4.4%) developed PEP (mild in 29 [85.3%], moderate in four [11.8%] and severe in one [2.9%]). Female gender, precut sphincterotomy, inadvertent PD cannulation and procedural time of > 30minutes predicted PEP in univariate analysis. Inadvertent PD cannulation (OR 4.6, 95% CI: 1.8-11.7; p < 0.001) and procedural time of > 30minutes (OR 8.5, 95% CI: 3.7-10.1; p < 0.001) were independent risk factors on multivariate analysis. When compared with historical controls, the odds of PEP with prophylactic use of rectal NSAIDs and selective PD stenting was 0.54 (CI: 0.31-0.93, p = 0.027). The number needed to treat (NNT) was 22 to prevent one PEP with prophylactic rectal NSAIDs. Routine use of prophylactic rectal NSAIDs effectively prevents the occurrence of PEP in unselected consecutive patients in a real-world scenario.

The role of rectal diclofenac and aggressive hydration with Ringer's lactate in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients

The role of rectal diclofenac and aggressive hydration with Ringer's lactate in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients

The safety and efficacy of Ringer's solution loading with rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: The RESOLUTION-PEP study.

We evaluated the safety and efficacy of aggressive hydration with rectal non-steroidal anti-inflammatory drugs for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). This prospective, single-arm, multicenter trial was conducted at 12 institutions between October 2020 and August 2021. We enrolled 231 patients who had intact papillae and were scheduled to undergo ERCP. All patients were administered rectal diclofenac before ERCP. They received aggressive hydration with intravenous lactated Ringer's solution in an initial bolus of 5 ml/kg at the start of ERCP, followed by 3 ml/kg/h for 8 h after the procedure. The primary outcome was the occurrence of PEP. Secondary outcomes included PEP severity, hyperamylasemia, and adverse events. The mean age of the patients was 68.8±13.7 years, and 81 patients (35.1%) were 75 years or older. Thirteen patients developed PEP (5.6%, 95% confidence interval 3.0%-9.4%). There were 11 cases (4.8%) of mild pancreatitis and two cases (0.9%) of severe pancreatitis. Forty-five patients (19.5%) developed hyperamylasemia and one patient developed non-severe peripheral edema. Aggressive hydration combined with rectal diclofenac may be a promising strategy for the prevention of PEP. Furthermore, it is safe even for older individuals.

Effect of Somatostatin Plus Diclofenac in Comparison with Diclofenac Before ERCP on the Pancreatitis Double Blinded Randomized Clinical Trial

<i>Background/Aims: </i>Despite many therapeutic attempts, post-retrograde cholangiopancreatography pancreatitis (PEP) has remained as a major challenge in interventional endoscopy. This study aimed to compare the effects of intravenous somatostatin plus rectal diclofenac with rectal diclofenac alone in the prevention of PEP.<i> Methods: </i>In a double-blind, randomized clinical trial, patients candidate for ERCP who accepted the study protocol were enrolled in the study between 2019 and 2021. The exclusion criteria include a history of pancreatobiliary surgery, ERCP, acute pancreatitis, contraindication, sensitivity to somatostatin, diclofenac, and pregnancy. PEP was defined as abdominal pain with elevated amylase level. Patients who received intravenous somatostatin plus diclofenac and diclofenac alone enrolled in case group and control group respectively. Patients were followed up for 24h after the procedure. Data regarding demographic, clinical presentation and laboratories results were recorded and compared.<i> Results: </i>A total 186 patients were enrolled, 91 in the case group and 95 as controls. There was no statistically significant difference between the two groups in terms of PEP incidence, complications or changes in serum amylase level (p > 0.05).<i> Conclusion: </i>Rectal diclofenac combined with intravenous somatostatin was superior to rectal diclofenac alone to prevent PE, but without a statistically significant difference, which is probably due to the synergic effect of somatostatin and diclofenac.

Impact of Postoperative Pain on Early Initiation of Breastfeeding and Ambulation After Cesarean Section: A Randomized Trial

Aim: To compare the effect of different analgesic regimens on the time to initiate breastfeeding (BF) and ambulation after cesarean section (CS). Methods: This prospective, double-blinded, placebo-controlled randomized study included 300 women (20-40 years of age) of the American Society of Anesthesiologists status 1 or 2 with singleton term pregnancies scheduled for CS under spinal anesthesia. Women were allocated to three groups of 100 each by computer-generated randomization. As an adjunct to 1,000 mg intravenous acetaminophen, Group 1 received 100 mg rectal diclofenac, Group 2 received 100 mg rectal tramadol, and Group 3 received rectal glycerin suppository. The time to initiate BF and ambulation was compared between different analgesic regimens and corelated with pain score. Results: BF (both with and without support) was initiated significantly earlier in Groups 1 and 2 as compared with control Group 3 (p < 0.001). A significantly shorter time was taken to initiate BF without support in Group 1 as compared with Group 2 (p = 0.028). The time to start ambulation (both with and without assistance) was significantly lower in Groups 1 and 2 as compared with Group 3 and in Group 1 versus Group 2 (p < 0.001). A significant positive correlation was found between the time to initiate BF with support and ambulation without assistance and postoperative pain score at 0, 1, and 6 hours. Conclusion: Effective post-CS analgesia affects early initiation of BF and ambulation in the immediate postnatal period. The inclusion of rectal diclofenac suppository in post-CS analgesic regimens is a promising approach to postoperative delivery care.