Single dose oral diclofenac for acute postoperative pain in adults

Barden, Jodie; Edwards, Jayne E; Moore, R Andrew; McQuay, HJ

doi:10.1002/14651858.cd004768

Cited by 28 publications

(5 citation statements)

References 57 publications

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“…The area under the curve (AUC) is a measure that is often used in clinical pharmacology, but it can also be used for clinical endpoints—for example, the use in pain assessment. 10 11 12 13 A higher AUC represents a higher satisfaction with pain relief. The AUC was calculated for the duration of labour and for the time that pain relief was administered.…”

Section: Methodsmentioning

confidence: 99%

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

Freeman

Bloemenkamp

Franssen

et al. 2015

BMJ

117

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Objective To determine women’s satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an intermediate to high obstetric risk with an intention to deliver vaginally. To exclude a clinically relevant difference in satisfaction with pain relief of more than 10%, we needed to include 1136 women. Because of missing values for satisfaction this number was increased to 1400 before any analysis. We used multiple imputation to correct for missing data. Intervention Before the onset of active labour consenting women were randomised to a pain relief strategy with patient controlled remifentanil or epidural analgesia if they requested pain relief during labour. Main outcome measures Primary outcome was satisfaction with pain relief, measured hourly on a visual analogue scale and expressed as area under the curve (AUC), thus providing a time weighted measure of total satisfaction with pain relief. A higher AUC represents higher satisfaction with pain relief. Secondary outcomes were pain intensity scores, mode of delivery, and maternal and neonatal outcomes. Analysis was done by intention to treat. The study was defined as an equivalence study for the primary outcome. Results 1414 women were randomised, of whom 709 were allocated to patient controlled remifentanil and 705 to epidural analgesia. Baseline characteristics were comparable. Pain relief was ultimately used in 65% (447/687) in the remifentanil group and 52% (347/671) in the epidural analgesia group (relative risk 1.32, 95% confidence interval 1.18 to 1.48). Cross over occurred in 7% (45/687) and 8% (51/671) of women, respectively. Of women primarily treated with remifentanil, 13% (53/402) converted to epidural analgesia, while in women primarily treated with epidural analgesia 1% (3/296) converted to remifentanil. The area under the curve for total satisfaction with pain relief was 30.9 in the remifentanil group versus 33.7 in the epidural analgesia group (mean difference −2.8, 95% confidence interval −6.9 to 1.3). For who actually received pain relief the area under the curve for satisfaction with pain relief after the start of pain relief was 25.6 in the remifentanil group versus 36.1 in the epidural analgesia group (mean difference −10.4, −13.9 to −7.0). The rate of caesarean section was 15% in both groups. Oxygen saturation was significantly lower (SpO 2 <92%) in women who used remifentanil (relative risk 1.5, 1.4 to 1.7). Maternal and neonatal outcomes were comparable between both groups. Conclusion In women in labour, patient controlled analgesia with remifentanil is not equivalent to epidural analgesia with respect to scores on satisfaction with pain relief...

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Section: Methodsmentioning

confidence: 99%

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

Freeman

Bloemenkamp

Franssen

et al. 2015

BMJ

117

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“…The non-selective non-steroidal anti-inflammatory drug (NSAID) diclofenac sodium has long been used to treat acute pain and inflammation [1], and is effective in various acute forms of pain [2]. Due to its poor solubility, the parenteral formulation of diclofenac sodium (Voltarol Ò ampoules) currently available in Europe contains the solvents propylene glycol and benzyl alcohol [3] that allows intramuscular and intravenous administration; intravenous Voltarol Ò requires reconstitution, dilution, buffering and slow infusion over C30 min [2,3].…”

Section: Introductionmentioning

confidence: 99%

Diclofenac Sodium Injection (Akis®, Dicloin®): A Review of Its Use in the Management of Pain

Blair

Plosker

2015

Clin Drug Investig

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A novel formulation of diclofenac sodium suitable for subcutaneous or intramuscular injection (Akis(®), Dicloin(®)) has been developed using the complexing agent hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer. Diclofenac HPβCD is available in several European countries, where it is indicated for use in adults with acute forms of pain, including postoperative pain. Clinical trials have demonstrated the analgesic efficacy of diclofenac HPβCD in terms of relieving moderate to severe postoperative pain in patients undergoing dental surgery or minor orthopaedic surgery. Subcutaneous diclofenac HPβCD also effectively relieved moderate to severe neuropathic pain, related to cancer or not. Diclofenac HPβCD was generally well tolerated in clinical trials, with injection-site reactions among the most commonly reported adverse events. The local tolerability of diclofenac HPβCD was consistently rated as 'good' or 'excellent' across all studies. Subcutaneous administration of diclofenac is a valid alternative to intramuscular delivery, with the advantages of easier administration, the availability of additional body sites suitable for injection and the potential for self-administration. Thus, diclofenac HPβCD 25, 50 or 75 mg/mL solution for subcutaneous or intramuscular injection extends the treatment options available for use in the management of pain in adults.

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“…Randomized controlled trials and their meta-analyses have shown that the use of celecoxib for all surgical procedures reduces pain scores and opioid consumption, expedites return of bowel function, return to normal daily activities and improves patients satisfaction1 4,15 . The COX-2 selective inhibitors have similar efficacy in the reduction of postoperative nausea and vomiting due to omission or opioid-sparing effects as nonselective NSAIDs, but they are superior in reducing other opioid adverse events 16 . The gastric ulceration rate was similar to placebo and significantly lower than nonselective NSAIDs in high-risk patients, even for short-term use 17 .…”

Section: Non-steroidal Anti-inflammatory Drugs (Nsaids) and Cyclooxyg...mentioning

confidence: 99%

Evidence-Based Strategies for Multimodal Postoperative Pain Management

Majerić Kogler

2023

ACC

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Surgery causes postoperative pain that should be immediately and effectively treated. Postoperative pain management is in central focus when planning postoperative treatment and is becoming the standard of care after surgical protocols -Enhanced Recovery after Surgery (ERAS). There are various serious complications associated with poorly controlled postoperative pain in adult surgical patients -cardiopulmonary complications, unplanned hospital admission, prolonged hospital stays, development of chronic pain, opioid side effects, opioid hyperalgesia and addiction. Studies have identified activation and sensitization of peripheral nociceptors and spinal dorsal horn neurons after surgical incision, and their specific mechanisms have been investigated. Basic scientific data and many clinical investigations suggest that different pain states result depending on the type and location of the incision, and that additional surgical procedures cause pain states of various severities in other sites. Supported by basic science, these observations have led to the development of the concept of procedure-specific postoperative pain management. The main value and novelty of procedure-specific postoperative pain management guidelines are that the guidelines are evidence-based, consider relevant patient characteristics, the role of anesthetic and surgical techniques, the balance between the invasiveness of the analgesic technique and the intensity of postoperative pain, as well as balance between analgesic efficacy and adverse event profile of the analgesic medications and procedures. In this review, the authors discuss the preventive and multimodal strategies of acute pain therapy, the pharmacotherapy of multimodal analgesia and local and regional techniques for specific surgical procedures.

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Single dose oral diclofenac for acute postoperative pain in adults

Cited by 28 publications

References 57 publications

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

Diclofenac Sodium Injection (Akis®, Dicloin®): A Review of Its Use in the Management of Pain

Evidence-Based Strategies for Multimodal Postoperative Pain Management

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