Prophylactic diclofenac infusions in major orthopedic surgery: effects on analgesia and acute phase proteins

Abstract

The influence of diclofenac, given by continuous i.v. infusion starting preoperatively, on postoperative pain and inflammation was assessed in a double-blind, randomized, placebo-controlled study in 40 patients scheduled for major orthopedic surgery. Starting 30 min before induction the patients received either diclofenac (0.35 mg.kg-1 bolus followed by a constant-rate infusion of 90 micrograms.min-1) or placebo for 24 h. The pain intensity (VAS) and the amount of rescue narcotic (piritramide on demand) were significantly lower in the diclofenac group from 4 and 6 h postsurgery, respectively, till end of infusion. Acute phase proteins used as inflammation markers (C-reactive protein, alpha 1-chymotrypsin, alpha 1-acid glycoprotein, haptoglobin and coeruloplasmin) showed similar variations in both groups for 24 h. The diclofenac treatment had no influence on hematological and coagulation profiles, nor on muscle and liver enzymes in comparison with placebo. Both patients and observer rated the diclofenac treatment as significantly superior to the placebo treatment.

Biochemical Measurement of Injury and Inflammation in Musculoskeletal Surgeries

“…This contrasts with the finding of a reduction in the IL-6 response, with no reduction in CRP, to peri-operative administration of ibuprofen in cholecystectomy (Chambrier et al, 1996). Finally, Diclofenic produced no reduction in the CRP response despite pre-treatment and 24 hours continuous infusion of the drug in their sample having various major surgeries (Claeys et al, 1992).…”

Acute phase response in patients undergoing lumbar spinal surgery: modulation by perioperative treatment with naproxen and famotidine

“…However, when used preoperatively, the results are conflicting, most probably due to the use of different surgical models and different dose regimens of the NSAIDs. In this regard, in a series of 40 patients scheduled for major orthopaedic surgery, the administration of diclofenac (intravenously 30 min before surgery followed by continuous intravenous infusion for 24 h) has been shown to reduce postoperative pain and analgesic consumption, although it did not induce changes in the postoperative CPR, AGP, HPT and CER levels during this period [4]. Similar results regarding amelioration of postoperative pain have been obtained with preopera-370 Fig.…”

Platelet function following administration of a novel formulation of intravenous diclofenac sodium versus active comparators: a randomized, single dose, crossover study in healthy male volunteers

“…The drug is available in both oral and rectal formulations. In addition, in Europe and Latin America, an injectable formulation (Voltarol, 75 mg/3 mL) is available for both IV and intramuscular administration, and was safe and effective in the treatment of postoperative pain in several randomized controlled trials [13][14][15][16][17][18][19][20]. Voltarol also has significant opioid-sparing effects in this setting [21].…”