Effect of intravenous diclofenac on pain and recovery profile after day-case laparoscopy.

Diclofenac sodium, 100 mg, or saline was given intravenously after the induction of anaesthesia to 169 patients undergoing outpatient gynaecological diagnostic laparoscopy or laparoscopic sterilization by tubal ligation. Propofol was used as the main anaesthetic agent and fentanyl and paracetamol were given for post-operative pain relief. In the post-anaesthesia care unit the amount of analgesics given and the incidence of nausea and vomiting were recorded. The time until oral intake, voiding and walking without assistance were recorded as parameters of recovery and guidelines for discharging the patient. In the diagnostic laparoscopy group, the patients given diclofenac needed significantly (P < 0.05) less fentanyl (25 +/- 33 micrograms, mean +/- SD) and paracetamol (230 +/- 40 mg) for post-operative pain than the patients given saline (fentanyl 47 +/- 53 micrograms and paracetamol 690 +/- 100 mg), which was not the case in the tubal ligation group. However, patients in the tubal ligation group needed significantly more post-operative analgesia than patients in the laparoscopy group. Diclofenac had no influence on the rapidity of recovery or home readiness in either group. It is concluded that diclofenac has no influence on home readiness, but prevents postoperative pain in patients undergoing diagnostic laparoscopies, whereas it was not a potent enough analgesic to prevent pain after laparoscopic tubal ligation.At Helsinki University Central Hospital in Finland, clinical researchers divided 169 women into two groups (group 1: diagnostic laparoscopies; group 2: laparoscopic sterilizations) as part of a study to evaluate the effect of intravenous diclofenac on postoperative pain, nausea, and recovery after outpatient gynecological laparoscopy. After induction of anesthesia (propofol infusion, total dose = about 370 mg), the patients randomly received, in a double-blind approach, either 100 mg diclofenac sodium (Voltaren, Ciba-Geigy) diluted in 10 ml saline or 10 ml saline alone. Patients in the saline group needed much more fentanyl and paracetamol for pain relief than those in the diclofenac group (47 vs. 25 mcg and 0.69 vs. 0.23 g, respectively; p 0.05). Even though a higher proportion of diclofenac patients experienced postoperative nausea and vomiting (17% vs. 6%) and thus were more likely to receive droperidol (9% vs. 2%), the differences were not statistically significant. Laparoscopic sterilization patients experienced more pain and required more pain relievers postoperatively than diagnostic laparoscopy patients. Specifically, sterilization patients receiving saline received 2.8 times more fentanyl and 1.9 times more paracetamol than diagnostic laparoscopy patients. As for diclofenac patients, these figures were 4.9 and 5.5, respectively. Sterilization patients had more nausea and vomiting than diagnostic laparoscopy patients (34% vs. 11%; p 0.001). Diclofenac did not influence the rapidity of recovery or home readiness in either group. These findings show that diclofenac significantly reduced the need for postoperative analgesia in diagnostic laparoscopy patients but not laparoscopic sterilization patients.