The Efficacy of Transdermal Diclofenac Patch For Postoperative Analgesia In Comparison With Intramuscular Diclofenac in Patients Undergoing Lower Abdominal and Perineal Surgeries under Sub-Arachnoid Block.

Abstract

Background: Post operative pain is a unique and common form of acute pain. Although ample evidence indicates that an efficacious post operative pain treatment reduces patient morbidity and improves patient outcome, recent studies demonstrate that about 50-70% of patients experience moderate to severe pain after surgery indicating that post operative pain remains poorly treated. The management of post operative pain is an essential and integral part of care given to the patient that assumes an important role in transition from the recovery unit to the home environment1. Aim: This clinical study was undertaken to evaluate the efficacy of Transdermal diclofenac patch vs IM diclofenac in patients undergoing lower abdominal and perineal surgeries under Subarachnoid block during postoperative period. Objectives: • To compare the efficacy of transdermal Diclofenac patch (100mg) with intramuscular Diclofenac (75mg) for postoperative analgesia in patients undergoing lower abdominal and perineal surgeries under subarachnoid block. • The time lapse between the operation and the first demand of analgesia by the patient (the need for rescue analgesia). • To know the side effects of transdermal and intramuscular diclofenac. Methodology: This randomised comparative study was conducted on 90 ASA I and II patients of either gender aged between 18 – 60 years posted for elective lower abdominal or perineal surgeries. The patients were randomly divided by computer generated tables into two groups of 45 patients in each group. Group A was applied with a Transdermal Diclofenac patch (100mg) at the beginning of surgery after subarachnoid block. DocuSign Envelope ID: 45FBAE40797C08F2--C690B2EE--443C05B1--98391B2C-D-A1151A79E3792CFBEC049D1 iv In groupB 75mg of Diclofenac sodium was given intramuscularly half an hour before the end of surgery. Data was analysed using Chi-square test and Mann Whitney U test Results: The mean difference in the time of administration of rescue analgesia in group A is 8hr 37 mins ± 1 hr 4.2 mins and group B is 6hrs 19 mins ±58.6 mins ( P value is < 0.0001 )that is highly significant. Side effects in group A were very minimal i.e. only 3 patients complained of local erythematous rash whereas in group B almost 13 patients developed nausea, vomiting, gastritis and pain at the injection site. Conclusion: Based on the results obtained we conclude that the application of transdermal diclofenac patch (100mg) significantly prolongs the time at which patient requires rescue analgesia compared to IM diclofenac (75mg). Thus transdermal diclofenac patch is effective, non- invasive and safer way of treating postoperative pain.