Preemptive diclofenac for post operative analgesia patients with major gynecologic abdominal surgery under general anesthesia in Adama hospital,Ethiopia,2020
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Date
2020-12
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Addis Abeba University
Abstract
Introduction
:
Preemptive analgesia has become one of the most promising strategies of pain
management. A significant proportion of patients suffer moderate to severe intensity of pain after
surgery. If not managed timely this can lead to prolonged hospital stay, return to the hospital after
discharge, reduction of the quality of life of the patients, development of chronic pain and organ
system complications.
Objective: The aim of this study was to assess the effectiveness of preemptive diclofenac
(75mg, IM) for postoperative pain management in patients that undergone gynecologic
abdominal surgery in Adama hospital.
Methods: This prospective cohort study recruits 90 ASA I and II, age>18 patients. Study
participants were selected by systematic random sampling technique. Study participants were
grouped as group D (who received preemptive diclofenac) and group N (who doesn’t receive
preemptive diclofenac). The outcome variables of the study were pain intensity, total analgesia
consumption, first analgesia request time and incidence of nausea and vomiting within 24 hrs.
postoperatively. Two samples ƶ-test and Mann Whitney U test was used for analyzing numeric
data. Categorical variable between two groups were analyzed using chi-square test. p -value
<0.05 is considered statistically significant.
Results: Median pain score in the first 24 hrs. post operatively in group D and group N
respectively was:- 2
nd
hr:3(2-4) vs 3(2-4) and 24
hr:1(0-2) vs 2(1-3), 4
th
th
hr:2(1-3) vs 3(2-4),8
th
hr:2(1-3) vs 4(3-5),12
hr:3(2-4) vs 3(2-4) with a p value of 0.007,0.004, 0.001,0.261 and
0.796 respectively. Mean first analgesia request time in group D and group N respectively was
186.60±35.19 and 174.45±24.88 with a p value of 0.087. Post-operative 24 hr. mean total
analgesic consumption in group D and group N respectively was: - diclofenac consumption:
146.25±50.81 vs 187.50±50.95 and Tramadol consumption: 153.75±44.41 vs 177.50±50.57 with
a p value of 0.0006 and 0.035 respectively.
Conclusion and Recommendation: Preemptive intramuscular administration of diclofenac
significantly decreases postoperative pain score and analgesic consumption in patients with
gynecologic abdominal surgery. Based on this we recommend intramuscular administration of
75mg of diclofenac 30 min to 1 hr. before surgery.
th
Description
Keywords
Analgesic consumption, first analgesia request, gynecologic abdominal surgery, post-operative pain, postoperative pain score, preemptive diclofenac.