Comparison of Diclofenac Patch and Intramuscular Diclofenac for Postoperative Analgesia in Abdominal Hysterectomy under Spinal Anesthesia: A Prospective, Randomized Clinical Study
Lopa H Trivedi, Deepshikha C Tripathi, Palak Chavda
Citation Information :
Trivedi LH, Tripathi DC, Chavda P. Comparison of Diclofenac Patch and Intramuscular Diclofenac for Postoperative Analgesia in Abdominal Hysterectomy under Spinal Anesthesia: A Prospective, Randomized Clinical Study. J Recent Adv Pain 2017; 3 (3):113-118.
Immediate postoperative period is very crucial and pain is maximum during first 24 hours. If patients are kept pain free during this period, it leads to vitally stable postoperative period, which in turn leads to early recovery. The aim of this study was to compare the analgesic efficacy of diclofenac sodium via two different routes, intramuscular (IM) and transdermal, in the management of postoperative pain.
Materials and methods
After informed written consent, 60 patients of American Society of Anesthesiologists (ASA) grades І to III scheduled for abdominal hysterectomy under subarachnoid blockade were randomized into two groups. Group TP (n = 30) received transdermal diclofenac patch 3 hours before surgery and group IM (n = 30) received IM diclofenac sodium 30 minutes before the end of surgery. Transdermal or IM diclofenac was repeated 12 hours later. Postoperative visual analog scale (VAS) scores, hemodynamic data, requirement of rescue analgesic, patient satisfaction, and adverse reaction if any were recorded every 2 hourly over 24 hours period. If VAS values were >4, 2 mg/kg tramadol was given intravenously as rescue analgesia.
Patient characteristic
Patient characteristics
Group TP (n = 30) (mean ± SD)
Group IM (n = 30) (mean ± SD)
p-value
Age (years)
42.56 ± 6.21
42.03 ± 5.85
>0.05
Weight (kg)
54.10 ± 8.54
55.50 ± 11.25
>0.05
Height (cm)
157.00 ± 2.69
156.40 ± 3.46
>0.05
ASA physical status (I/II)
9/21
7/23
>0.05
Duration of surgery (min)
74.00 ± 17.78
73.66 ± 16.50
>0.05
Mean vas pain score comparison in each group
Time
Group TP (mean ± SD)
Group IM (mean ± SD)
p-value
2 hours
0.33 ± 0.66
0.30 ± 0.59
>0.05
4 hours
1.40 ± 1.13
1.03 ± 1.12
>0.05
6 hours
1.86 ± 0.86
1.70 ± 1.11
>0.05
8 hours
2.36 ± 0.71
2.60 ± 0.96
>0.05
10 hours
2.93 ± 0.86
3.06 ± 0.82
>0.05
12 hours
3.10 ± 0.84
2.86 ± 0.62
>0.05
14 hours
2.30 ± 0.83
2.03 ± 0.41
>0.05
16 hours
1.86 ± 0.57
1.70 ± 0.53
>0.05
18 hours
1.90 ± 0.48
1.80 ± 0.80
>0.05
20 hours
1.83 ± 0.37
1.76 ± 0.56
>0.05
22 hours
1.86 ± 0.50
2.00 ± 0.74
>0.05
24 hours
2.13 ± 0.62
2.30 ± 0.71
>0.05
Results
Postoperative VAS, hemodynamic data, requirement of rescue analgesia, and patients’ satisfaction were comparable in both the groups (p > 0.05). Intramuscular diclofenac has more side effects.
Conclusion
Diclofenac transdermal patch provided postoperative pain relief as effectively as IM diclofenac for abdominal hysterectomy, without any significant side effects.
How to cite this article
Gupta M, Trivedi LH, Tripathi DC, Chavda P. Comparison of Diclofenac Patch and Intramuscular Diclofenac for Postoperative Analgesia in Abdominal Hysterectomy under Spinal Anesthesia: A Prospective, Randomized Clinical Study. J Recent Adv Pain 2017;3(3):113-118.
Hysterectomy rates in the United States, 2003. Obstetric Gynecol 2007 Nov;110(5):1091-1095.
; Bonica, JJ. Peripheral pain mechanisms and nociceptor plasticity. In: Loeser, JD, editor. Management of pain. New York (NY): Lippincott Williams & Wilkins; 2001. pp. 26-72.
; Bonica, JJ. Peripheral pain mechanisms and nociceptor plasticity. In: Loeser JD, editor. Management of pain. New York (NY): Lippincott Williams & Wilkins; 2001. pp. 73-152.
; Akil, H. Goodman & Gilman’s the pharmacological basis of therapeutics. In: Hardman JG, Limbird LE, Gilman AG, editors. Opioid analgesics. 10th ed. New York (NY): McGraw Hill; 2002. pp. 569-619.
Postoperative pain – clinical implications of basic research. Best Pract Res Clin Anaesthesiol 2007 Mar;21(1):3-13.
Side effects of opioids during short-term administration: effect of age, gender, and race. Clin Pharmacol Therap 2003 Aug;74(2):102-112.
Update on the role of non-opioids for postoperative pain treatment. Best Pract Res Clin Anaesthesiol 2007 Mar;21(1):15-30.
A single rectal diclofenac dose reduces post haemorrhoidectomy urine retention. Cir Esp 2008 Jun;83(6):301-305.
Colonic ulceration and bleeding during diclofenac therapy. N Engl J Med 1990 Jul;323(2):135.
Determination of the transdermal bioavailability of a newly developed diclofenac sodium patch in comparison with a reference preparation. Arzneimittelforschung 2005 Feb;55(7):403-413.
The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg 1993 Nov;77(5):1048-1056.
Consequences of inadequate pain relief and chronic persistent postoperative pain. Anesthesiol Clin North Am 2005 Mar;23(1):21-36.
Current trends in perioperative pain management. Anesthesiol Clin North Am 2000 Sep;18(3):575-599.
Risk factors for chronic pain after hysterectomy – a nationwide questionnaire and database study. Anesthesiology 2007 May;106(5):1003-1012.
A prospective study of risk factors for pain 4 months after hysterectomy. Clin J Pain 2009 May;25(4):263-268.
Mechanosensitivity before and after hysterectomy: a prospective study on the prediction of acute and chronic postoperative pain. Br J Anaesth 2011 Dec;107(6):940-947.
Chronic pain after hysterectomy. Acta Anaesthesiol Scand 2008 Mar;52(3):327-331.
; Grace, PA.; Dargi, A., et al. Pain relief. In: Clinical surgery. 2nd ed. Malden (MA): Blackwell Publishing Ltd; 2003. pp. 101-108.
Evaluation of a diclofenac transdermal patch for the attenuation of venous cannulation pain: a prospective, randomized, double blind, placebo-controlled study. Anaesthesia 2006 Apr;61(4):360-362.
Efficacy of a single dose of a transdermal diclofenac patch as pre-emptive postoperative analgesia: a comparison with intramuscular diclofenac. South Afr J Anaesth Analg 2012 Mar;18(4):194-197.
Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case-control study. BMJ 1995 Jul;311(6996):22-26.
NSAID-associated adverse effects and acid control aids to prevent them: a review of current treatment options. Drug Saf 2006 Feb;29(2):119-132.
A prolonged release parenteral drug delivery system. Int J Pharm Sci Rev Res 2010 Jul-Aug;3(1):1-11.
The comparative effects of transdermal and intramuscular diclofenac on postlaparoscopic surgery pain. Surg Laparosc Endosc Percutan Tech 2012 Aug;22(4):374-378.
Postoperative analgesia with transdermal diclofenac versus intramuscular diclofenac – a comparative study. JEMDS 2013 May;2(19):3367-3376.
A study of efficacy of a single dose of a transdermal diclofenac patch and intramuscular diclofenac- as pre-emptive postoperative analgesia in patients undergoing abdominal hysterectomy. Int J Res Med 2015;4(4):96-101.
Comparative study in management of post-operative pain with diclofenac patch versus diclofenac injection. CIBTech J Surg 2015 Jan-Apr;4(1):10-15.
Post operative pain relief: comparison of transdermal diclofenac patch with intra muscular diclofenac injection. Indian J Clin Anaesth 2016;3(1):56-61.
Comparing the effectiveness of transdermal diclofenac patch and intramuscular diclofenac injection in postoperative pain relief after inguinal hernia mesh repair: a randomised study in the department of general surgery. J Evid Based Med Healthcare 2015 Aug;2(34):5286-5292.
Efficacy and safety of transdermal diclofenac patch versus intramuscular diclofenac injections in postoperative patients of inguinal hernia. Int J Basic Clin Pharmacol 2016 Mar-Apr;5(2):447-452.
Topical NSAIDs for acute pain: a meta-analysis. BMC Fam Pract 2004 May;5:10.
