Diclofenac Suppository vs. IV Acetaminophen Combined With IV PCA for Postoperative Pain Management in Patients Undergoing Laminectomy: A Randomized, Double-Blinded Clinical Trial

Abstract

BackgroundTissue damage caused by surgical procedures nearly always results in pain. The effective management of postoperative pain remains a challenge because of its influence on the surgical outcome and its critical role in early mobilization and functionality. Recent research on postoperative pain management supports a treatment approach known as “multimodal analgesia,” which comprises the use of more than one method or modality of pain control and management.ObjectivesIn the present study, we compared the effects of diclofenac suppository and intravenous (IV) acetaminophen combined with IV patient-controlled analgesia (PCA) for pain management after laminectomy surgery.Patients and MethodsOur randomized, double-blinded controlled trial during 2013 at Besat hospital in Hamadan, Iran, included 102 ASA I-II patients aged 18 to 65 years who were candidates for laminectomy surgery. The patients were randomly assigned to receive the diclofenac suppository (100 mg) (n = 51) or IV acetaminophen (1 g in 100 mL normal saline) (n = 51) 10 minutes before completing surgery and 12 hours after the operation.ResultsThe patients’ characteristics were the same in both study groups. The patients’ satisfaction levels were higher among those who received diclofenac when compared with the acetaminophen group, especially at the time points of 6 and 12 h after surgery. The consumed narcotic using the PCA pump within 24 h of surgery in the diclofenac group was significantly lower than that of the acetaminophen group (735.70 ± 59.61 µg vs. 819.70 ± 80.02 µg; P < 0.001).ConclusionsThe use of diclofenac suppository combined with IV PCA results in reduced narcotic usage and a higher level of patient satisfaction compared to the use of IV acetaminophen combined with IV PCA.

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

“…However, the opioid-sparing effects of paracetamol are well described, and for this reason, paracetamol is also recommended for lumbar laminectomy. Furthermore, both Kesimci et al and Nikosereth et al reported no significant difference in post-operative pain scores between NSAIDs and paracetamol [12,16].…”

“…Nikooseresh et al compared diclofenac 100 mg suppository to IV paracetamol 1000 mg [16]. Rescue analgesia included IV-PCA fentanyl.…”