Intravenous Diclofenac Coupled with PCA Fentanyl for Pain Relief after Total Hip Replacement

Laitinen, J; Nuutinen, L

doi:10.1097/00000542-199202000-00006

Cited by 90 publications

(40 citation statements)

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“…Further, the results of the present analysis support previous studies that suggest that diclofenac is not associated with added risk of postoperative bleeding complications versus placebo in the postsurgical setting [59][60][61]. Similarly, a study in patients undergoing transurethral prostate resection reported no added bleeding risk with the use of intramuscular diclofenac versus IV paracetamol [62].…”

Section: Discussionsupporting

confidence: 87%

Clinical and Laboratory Hematologic Findings in Patients Receiving Repeated-Dose Injectable HPBCD-Diclofenac for Acute Postoperative Pain: Pooled Analysis of Two Randomized Controlled Phase III Clinical Trials

Gan¹,

Singla²,

Daniels³

et al. 2015

J Anesth Clin Res

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Objective: While the non-steroidal anti-inflammatory drugs (NSAIDs) represent an important option for the management of acute postoperative pain, their use can be limited due to potential safety concerns, including bleeding risks. This study examined the bleeding-related safety of injectable diclofenac formulated with hydroxypropyl-β-cyclodextrin (HPβCD-diclofenac) when used for postoperative pain management. Methods:Data from two randomized, double-blind, placebo-and active comparator-controlled phase III trials were pooled. Patients in both studies received HPβCD-diclofenac, placebo, or the active comparator ketorolac via intravenous injection every 6 hours for ≤ 5 days following abdominal/pelvic or orthopedic surgery. Bleeding adverse events (AEs) were evaluated through the treatment period and follow-up (≤ 37 days), and relative bleeding AE risks (RR) were estimated. Changes in hematology laboratory values were also assessed.Results: Overall, 608 surgical patients received ≥ 1 dose of study medication. Bleeding AEs occurred in n=9/318 (2.8%) patients receiving HPβCD-diclofenac, n=8/142 (5.6%) patients receiving ketorolac, and n=4/148 (2.7%) patients receiving placebo. Over the period examined, HPβCD-diclofenac was not associated with increased bleeding AE RR versus placebo (1.05 [0.33, 3.35]; p=0.93), nor was ketorolac (2.08 [0.64, 6.77]; p=0.22). Bleeding AEs were predominantly mild or moderate in severity. No treatment-related bleeding AEs occurred in the HPβCD-diclofenac group (1 in both the placebo and ketorolac groups). Among the subset of patients receiving concomitant anticoagulants, bleeding AEs occurred in n=3/60 (5.0%) patients receiving HPβCD-diclofenac, n=2/29 (6.9%) patients receiving ketorolac, and n=0/35 patients receiving placebo. In the HPβCD-diclofenac group, postsurgical shifts to low hematocrit and hemoglobin occurred in 35.7% and 28.3% of patients, respectively (versus 31.4% and 21.5%, respectively, with placebo). Postsurgical shifts in platelet count were uncommon (<3.0% across treatment groups). Conclusions:While follow-up studies in larger populations are warranted, this analysis suggests that HPβCD-diclofenac may not present a significant incremental bleeding AE risk versus placebo when used for acute postoperative pain management.

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Section: Discussionsupporting

confidence: 87%

Clinical and Laboratory Hematologic Findings in Patients Receiving Repeated-Dose Injectable HPBCD-Diclofenac for Acute Postoperative Pain: Pooled Analysis of Two Randomized Controlled Phase III Clinical Trials

Gan¹,

Singla²,

Daniels³

et al. 2015

J Anesth Clin Res

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“…Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce morphine requirements in variety of surgical procedures and are devoid of CNS side effects typical of narcotics. [5][6][7][8] Non-steroidals exert their anti-nociceptive action by blocking the peripheral synthesis of prostaglandins by inhibiting the cyclo-oxygenase enzyme one (COX-1), although a central mechanism has recently being proposed. Non-steroidals also inhibit prostaglandin synthesis by inhibiting the cyklooxygenase enzyme two (COX-2) which causes platelet dysfunction, may cause renal impairment by blood flow redistribution in kidneys and are responsible for gastrointestinal symptoms.…”

Section: Discussionmentioning

confidence: 99%

Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery

Hynninen

Cheng

Hossain

et al. 2000

Can J Anesth/J Can Anesth

100

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Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are used as analgesic in postoperative pain to reduce opioid side effects, such as drowsiness and nausea. However, NSAIDs have not been used extensively in cardiac surgical patients due to the fear of untoward effects on gastric, renal, and coagulation parameters. This study will evaluate the efficacy and safety of three NSAIDs for pain control in CABG patients. Methods:One hundred and twenty patients scheduled for elective CABG surgery were enrolled in randomized, double blind, controlled study. Standardized fast track cardiac anesthesia was used. One dose of drug (75 mg diclofenac, 100 mg ketoprofen, 100 mg indomethacin, or placebo) was given pr one hour before tracheal extubation and a second dose 12 hr later. Pain was treated with morphine iv and acetaminophen po. Visual analogue pain scores were recorded at baseline, 3, 6, 12 and 24 hr after the first dose of drug.Results: There were no differences among the groups in pain scores. Only patients who received diclofenac required less morphine than patients in the control group (P < 0.05). When the total amounts of pain medications were computed to morphine equivalents, only patients in the diclofenac group received less pain medications than the placebo group (P < 0.05). Proportion of patients with postoperative increase of creatinine level (20% and over) did not differ between placebo and drug groups.Conclusion: Non-steroidal anti-inflammatory drugs may be used for analgesia management post CABG surgery in selected patients. Diclofenac appears to have the best analgesic effects by reducing the morphine and other analgesic requirement postoperatively.Objectif: Les anti-inflammatoires non stéroïdiens (AINS) servent d'analgésique postopératoire et réduisent les effets secondaires des opioïdes, comme la somnolence et les nausées. Leur emploi en cardiochirurgie est plutôt restreint où on craint des effets gastriques et rénaux indésirables et des modifications de la coagulation. On a voulu évaluer l'efficacité et la sécurité d'emploi analgésique de trois AINS chez des patients qui subissent un pontage aortocoronarien.Méthode : L'étude randomisée, contrôlée et à double insu a porté sur 120 patients qui devaient subir un pontage aortocoronarien. Une anesthésie cardiaque normalisée pour un séjour hospitalier écourté a été utilisée. Une dose de médicament (75 mg de diclofénac, 100 mg de kétoprofène, 100 mg d'indométhacine, ou un placebo) a été administrée pr une heure avant l'extubation endotrachéale et une seconde dose 12 h plus tard. La douleur a été traitée avec de la morphine iv et de l'acétaminophène po. Les scores de douleur ont été enregistrés à l'échelle visuelle analogique au début, puis 3, 6, 12 et 24 h après la première dose de médicament.Résultats : Les scores de douleur n'ont pas présenté de différence intergroupe. Seuls les patients du groupe diclofénac ont demandé moins de morphine que ceux du groupe témoin (P < 0,05). Lorsque les quantités totales d'analgésiques ont été calculées en équivalents de...

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“…18 Small intermittent dose of intravenous pethidine groups showed effective and safe analgesia in this study which was compared with intravenous PCA based combined analgesic studies using morphine, fentanyl, indomethacine and diclofenac. 7,11,17 Early analgesia (within 30 min) was achieved in this study with small does of intravenous pethidine which was compared with PCA based single opioid therapy 19,20,21,22 . PCA therapy is considered to be a safe but high doses of opioid was required.…”

Section: Discussionmentioning

confidence: 90%

“…The post operative pain relief immediately after major surgery can not be achieved with opioids alone in all patients without respiratory depression or other significant side effects 7 . So it is not always applicable or without side effect and require skill manpower.…”

mentioning

confidence: 99%

Effect of small dose intermittent IV pethidine in combination with diclofenac for post operative pain relief

Banik

Hye

Akhtaruzzaman

et al. 2014

j Bangladesh Soc Anaesthesiologists

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Background: Post operative pain is an acute type of pain. There is convincing evidence that unrelieved post operative pain may result in harmful physiological and psychological effects with significant morbidity and even mortality. Complete and effective pain management is an essential for the patient who recovers from surgery. For this reason we used easy available drugs opioid, NSAID and its combination for better post operative analgesia with the aim of avoiding expensive patient controlled analgesia technique, infusion or intramuscular painful roout of administration. Methods: 120 patients ASA grade-I and II were selected for post operative pain releive in upper and lower abdominal surgery. All patients divided into three groups and each group are equal in number and same type of surgery. Among the three groups, two groups received small intermittent intravenous pethidine and diclofenac pre and post operatively and other groups received intra muscular pethidine with diclofenac pre and post operatively (controlled group). All vital parameter and pain score both VAS and VRS were recorded in perioperative period up to 24 hours postoperatively. Result: Good level of anaesthesia was achieved in all groups (VAS>30mm) of upper and lower abdominal surgery except early post operative period. In early post operative period significant difference of VAS in group II and III (P<.01) was found with group I. But after half an hour and one hour significant difference of VAS in group II and III (P<0.02, P<0.001) was found with group I. Over all excellent analgesia was possible in group II VAS, VRS always more than 30mm and all vital sign were stable. Conclusion: Small intravenous intermittent dose of pethidine in combination with diclofenac sodium effectively controlled post-operative pain. DOI: http://dx.doi.org/10.3329/jbsa.v22i2.18140 Journal of BSA, 2009; 22(2): 40-47

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Intravenous Diclofenac Coupled with PCA Fentanyl for Pain Relief after Total Hip Replacement

Cited by 90 publications

References 0 publications

Clinical and Laboratory Hematologic Findings in Patients Receiving Repeated-Dose Injectable HPBCD-Diclofenac for Acute Postoperative Pain: Pooled Analysis of Two Randomized Controlled Phase III Clinical Trials

Clinical and Laboratory Hematologic Findings in Patients Receiving Repeated-Dose Injectable HPBCD-Diclofenac for Acute Postoperative Pain: Pooled Analysis of Two Randomized Controlled Phase III Clinical Trials

Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery

Effect of small dose intermittent IV pethidine in combination with diclofenac for post operative pain relief

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