DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20183640

Comparison of intramuscular diclofenac sodium, diclofenac sodium suppository and intravenous tramadol for postoperative analgesia in gynaecological surgeries done under spinal anaesthesia

Sonali Mahendra Khobragade

Abstract


Background: Postoperative pain management is a vital factor contributing towards speedy recovery of the patient in the perioperative period without significant morbidity. The purpose of this study was to compare the analgesic efficacy and safety of three most frequently used analgesic drugs-intramuscular diclofenac sodium, diclofenac suppository and intravenous tramadol hydrochloride in patients undergoing gynaecological surgeries.

Methods: A hospital based, prospective, randomized, comparative study was undertaken in tertiary care hospital for a period of two years. The study included 90 adult patients undergoing gynaecological surgeries in spinal anaesthesia. Postoperative pain intensity was assessed by visual analogue scale. Level of sedation was assessed by four point scale along with haemodynamics.

Results: There were no significant changes in the pulse rate, systolic blood pressure and diastolic blood pressure after giving I.M. diclofenac, diclofenac suppository and I.V. tramadol. The mean VAS scores were comparable in all three groups (p>0.05). The level of sedation was more in tramadol group than in diclofenac intramuscular and rectal group which was statistically significant (p=0.001).

Conclusions: Diclofenac suppository provides effective postoperative analgesia when compared with Inj. Diclofenac I.M. and Inj. tramadol I.V. in patients undergoing infraumbilical gynaecological surgeries with stable vitals and no side effects.


Keywords


Diclofenac sodium intramuscular, Diclofenac suppository, Postoperative analgesia, Tramadol

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References


Elsharkawy H, Naguib Mohamed A. Stoelting’s textbook of pharmacology and physiology in anaesthetic practice: 5th edition; Peripherally acting analgesics. 2014:269-275.

Cummings K, Naguib Mohamed A. Stoelting’s textbook of pharmacology and physiology in anaesthetic practice: 5th edition; Opioid agonists and antagonists. 2015:217-241.

Canepa G, Di CS, Ghia M, Vadala A, Reali M, Cerruti S, et al. Post-operative analgesia with tramadol: a controlled study compared with an analgesic combination. Inter J Clin Pharmacol Res. 1993;13(1):43-51.

Rud U, Fischer MV, Mewes R, Paravicini D. Postoperative analgesia with tramadol, continuous infusion versus repetitive bolus administration. Anaesthetist. 1994;43(5):316-21.

Sachs CJ. Oral analgesics for acute nonspecific pain. American family physician. 2005 Mar 1;71(5).

Gillberg LE, Harsten AS, Stahl LB. Preoperative diclofenac sodium reduces postlaparoscopy pain. Canadian J anaesthesia. 1993 May 1;40(5):406-8.

Cabrera Magana EN, Solis EJ, Lopes RC. Tramadol in the management of gyneco-obstretic pain. Ginecolobstet Mex. 1997;65:152-4.

Scott RM, Jennings PN. Rectal diclofenac analgesia after abdominal hysterectomy. Aust NZ J Obs Gynaecol. 1997;37(1):112-4.

Chen D, Clement Y, Simeon D, Pinto PLM. Analgesic effects of diclofenac suppository and injection after preoperative administration. Int J Clin Pharm Res. 1999;19(2):47-51.

Boulert A. Diclofenac intramuscular single dose to decrease pain in postoperative cesarean section: a double blind randomized control trial. J of Med Asso Thai. 2005;88(1):9-15.

Karamen S, Uysaller E, Firat V. the use of tramadol for pain relief after abdominal hysterectomy. Clin Exp Obs Gyn. 2005;32(1):45-8.

Surakaran J, Yeun T. Intramuscular diclofenac for analgesia after cesarean delivery: a randomized control trial. J Med Asso Thai. 2009;92(6):733-8.

Patil RK, Samal S, Pattnaik SK, Jena SK. The effectiveness of intravenous tramadol hydrochloride and diclofenacsoium as postoperative analgesia:a comparative study. Int J Pharm Sci Rev Res. 2016;36(1):260-3.

Merrikhihaji S, Farshchi A, Farshchi B, Farshchi S, Dorkoosh FA. Tramadol versus diclofenac in pain management after cesarean section: a cost nalysis study. J pharmacoeconomics and pharmaceutical management. 2015;1(1):22-4.

Sahil S, Mane M, Paranjape J. Comparison of diclofenac suppository with tramadol suppository for postoperative analgesia in abdominal hysterectomy patients. Medpulse-International medical J. 2017;4(5):606-9.

Gupta M, Trivadi LH, Tripathi DC, Chavda P. Comparison of diclofenac patch and intramuscular diclofenac for postoperative analgesia in abdominal hysterectomy under spinal anaesthesia: A prospective randomized clinical study. J recent advances in pain. 2017;3(3):113-8.

Shukla AK, Srivastava AK. Comparative study of tramadol and diclofenac as analgesic for postoperative pain. Int. J Med Res Rev. 2015;3(11):1311-6.

Al Waili NS. Efficacy and safety of repeated postoperative administration of intramuscular diclofenac sodium in the treatment of post-cesarean section pain: a double blind study. Archieves of Med Res. 2001;32(2):148-54.

Dahl V, Hagen IE, Sveen AM, Norseng H, Koss KS. High dose of diclofenac for postoperative analgesia after elective cesarean section in regional anaesthesia. Inter J Obstetric Anaesthesia. 2002;11(2):91-4.

Karaca M, Kocoglu H, Gocman A. Comparison of tramadol with lornoxicam in patient controlled analgesia after gynecological surgery. Euro J Gynecol Oncol. 2006;27(1):78-80.

Paudel R, Deka A, Gupta HK, Nepal HP. Comparative evaluation of analgesic efficacy of tramadol and diclofenac sodium in postoperative orthopedic patients. Int J Basic Clin Pharm. 2017;6(11):2676-83.

Searles JA, Prings DW. Effective analgesia following perineal injury during childbirth: a plcebo controlled trial of prophylactic rectal diclofenac. British J Obs Gyn. 1998;105(6):627-31.