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Opioid sparing effect of diclofenac sodium when used as an intra-operative analgesic during maxillofacial cancer surgeries.

Bhoyar K, Patil V, Shetmahajan M - Indian J Anaesth (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.

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Consequently, maxillofacial cancer surgery constitutes a large part of surgical oncology practice in India... Traditionally, strong analgesics such as opioids have been used intra-operatively whereas non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are most commonly given at the end of surgery as part of multimodal approach to post-operative analgesia... Hence, there is a tendency to restrict use of NSAIDs in these patients... We hypothesized that addition of single dose of diclofenac at the time of induction would exert opioid sparing effect during intra-operative period and reduce surges in blood pressure (BP) and pulse rate during noxious stimuli... The subjects included 100 adult patients more than 18 years of age posted for maxillofacial surgery with reconstructive surgery... The patients recruited to the study were randomised prior to anaesthesia to either Group 1 (Placebo Group) to receive 100 cc normal saline after induction of anaesthesia and Group 2 (Diclofenac Group) to receive diclofenac sodium 1 mg/kg in 100 cc normal saline IV after induction of anaesthesia... Our study showed that diclofenac administered at the beginning of surgery reduced opioid required to control the haemodynamic response to surgical stimulation... During balanced anaesthesia, optimum analgesia reduces the dose of anaesthetic agents and muscle relaxants resulting in a better post-operative recovery... Better analgesia also helps to maintain cardiovascular stability... Succinylcholine and vecuronium used in the study have different effects on pulse rate, but the effect is short lasting and would not affect results as interval between induction and incision usually exceeds 15 min... Similarly, assessors and anaesthesiologist conducting case and patient were not aware about the method of randomisation, minimizing chance of bias... Diclofenac when given as an intra-operative analgesic reduced fentanyl consumption in the intra-operative period with extension of analgesia into the early post-operative period... Patients receiving diclofenac were significantly less sedated than those in the Placebo Group.

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Comparison of pain score and sedation score in immediate post-operative period
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Figure 2: Comparison of pain score and sedation score in immediate post-operative period

Mentions: Patients in the control group consumed significantly more IV fentanyl boluses intra-operatively than in the placebo (2.84 vs. 0.74, P < 0.01) mainly during the phase of incision and time of removal of specimen that requires bone cuts [Figure 1]. Patients in the Diclofenac Group also had better pain and sedation scores on arrival to recovery (time 0) which was statistically significant. Mean pain intensity at rest which was measured on VAS at arrival was 3.30 ± 0.65 in Placebo Group compared to 2.10 ± 0.30 in the Diclofenac Group which was significant (P < 0.01). Sedation scores on arrival in recovery room were 2.58 ± 0.57 and 1.66 ± 0.63 in the Placebo and Diclofenac Group, respectively (P < 0.01). Time to demand for first dose of analgesia in post-operative period was significantly shorter for group 1 (114.5 min vs. 252.6 min P < 0.01) [Figure 2].


Opioid sparing effect of diclofenac sodium when used as an intra-operative analgesic during maxillofacial cancer surgeries.

Bhoyar K, Patil V, Shetmahajan M - Indian J Anaesth (2015)

Comparison of pain score and sedation score in immediate post-operative period
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697250&req=5

Figure 2: Comparison of pain score and sedation score in immediate post-operative period
Mentions: Patients in the control group consumed significantly more IV fentanyl boluses intra-operatively than in the placebo (2.84 vs. 0.74, P < 0.01) mainly during the phase of incision and time of removal of specimen that requires bone cuts [Figure 1]. Patients in the Diclofenac Group also had better pain and sedation scores on arrival to recovery (time 0) which was statistically significant. Mean pain intensity at rest which was measured on VAS at arrival was 3.30 ± 0.65 in Placebo Group compared to 2.10 ± 0.30 in the Diclofenac Group which was significant (P < 0.01). Sedation scores on arrival in recovery room were 2.58 ± 0.57 and 1.66 ± 0.63 in the Placebo and Diclofenac Group, respectively (P < 0.01). Time to demand for first dose of analgesia in post-operative period was significantly shorter for group 1 (114.5 min vs. 252.6 min P < 0.01) [Figure 2].

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Consequently, maxillofacial cancer surgery constitutes a large part of surgical oncology practice in India... Traditionally, strong analgesics such as opioids have been used intra-operatively whereas non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are most commonly given at the end of surgery as part of multimodal approach to post-operative analgesia... Hence, there is a tendency to restrict use of NSAIDs in these patients... We hypothesized that addition of single dose of diclofenac at the time of induction would exert opioid sparing effect during intra-operative period and reduce surges in blood pressure (BP) and pulse rate during noxious stimuli... The subjects included 100 adult patients more than 18 years of age posted for maxillofacial surgery with reconstructive surgery... The patients recruited to the study were randomised prior to anaesthesia to either Group 1 (Placebo Group) to receive 100 cc normal saline after induction of anaesthesia and Group 2 (Diclofenac Group) to receive diclofenac sodium 1 mg/kg in 100 cc normal saline IV after induction of anaesthesia... Our study showed that diclofenac administered at the beginning of surgery reduced opioid required to control the haemodynamic response to surgical stimulation... During balanced anaesthesia, optimum analgesia reduces the dose of anaesthetic agents and muscle relaxants resulting in a better post-operative recovery... Better analgesia also helps to maintain cardiovascular stability... Succinylcholine and vecuronium used in the study have different effects on pulse rate, but the effect is short lasting and would not affect results as interval between induction and incision usually exceeds 15 min... Similarly, assessors and anaesthesiologist conducting case and patient were not aware about the method of randomisation, minimizing chance of bias... Diclofenac when given as an intra-operative analgesic reduced fentanyl consumption in the intra-operative period with extension of analgesia into the early post-operative period... Patients receiving diclofenac were significantly less sedated than those in the Placebo Group.

No MeSH data available.