Effect of Intramuscular Diclofenac after Explore Laparotomy for Gynecologic Surgery: A Randomized Double-Blinded Placebo Controlled Trial
Yuthadej Thaweekul MD*, Komsun Suwannarurk MD*, Karicha Maireang MD*, Yenrudee Poomtavorn MD*
Affiliation : * Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : Several adjuvant analgesic agents proposed to treat the postoperative pain while reducing the doses of opioid
and its derivatives. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in several operative procedures. The
present study aimed to demonstrate the morphine-sparing effects of single-dose intramuscular diclofenac sodium in explore
laparotomy gynecologic surgery.
Material and Method: Forty-six patients were randomly assigned to receive 75-mg of diclofenac sodium or normal saline
with intramuscular morphine during immediate postoperative period. Additional morphine for pain control was given by
patient-controlled analgesia. 24-hour morphine consumption, pain score, adverse effects and satisfaction of the patients were
recorded.
Results : Median morphine consumption among groups was significant difference between placebo and diclofenac group (32
and 19 mg) (p = 0.041). Greater difference was shown in patients who underwent total abdominal hysterectomy (p = 0.009).
Catagorical pain score at 6-hour postoperatively was significant lower in diclofenac group (p = 0.006). No significant
difference was found between groups in visual analogue pain score, patients’ satisfaction, presence of bleeding or nausea and
vomiting.
Conclusion : The present study demonstrated that single dose of diclofenac sodium has morphine-sparing effects and can be
safely used in explore laparotomy gynecologic surgery without significant adverse effects.
Keywords : Intramuscular diclofenac, Randomized controlled trial, Gynecologic surgery
