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Single dose diclofenac suppository reduces post-Cesarean PCEA requirements

Abstract

Purpose: To assess the analgesic efficacy of administering, immediately after surgery, a single dose of diclofenac (100 mg suppository) to women who had undergone lower segment Cesarean section (LSCS) under combined spinal-epidural anesthesia, and received post-operative patient-controlled epidural analgesia (PCEA) with ropivacaine 0.2% and fentanyl 2 µg·ml−1.

Methods: Forty-eight ASA physical status I or II term parturients scheduled for elective LSCS under regional anesthesia were enrolled into this randomised double-blind study. The patient-controlled epidural analgesia device was programmed to deliver a bolus of 4 ml of local anesthetic mixture with a lockout period of ten minutes and an hourly limit of 12 ml. There was no baseline infusion. The study commenced upon the patient’s first demand for analgesia post-operatively and the patients were assessed at one, six, 12 and 24 hr post-operatively for pain scores on movement, dermatomal level of sensory blockade, degree of motor blockade and volume of local anesthetic used. At conclusion of the study, patients’ satisfaction scores were recorded.

Results: The two groups of patients were similar demographically. Patients who received a diclofenac suppository used 52.8±17.8 ml of local anesthetic mixture while those who did not, used 74± 25 ml (P <0.005). Pain scores and satisfaction scores did not differ significantly between the groups.

Conclusion: A single adminstration of 100 mg diclofenac suppository is effective in reducing post-Cesarean epidural local anesthetic/opioid requirements by 33% for the first 24 hr post-operatively.

Résumé

Objectif: Évaluer l’efficacité analgésique de l’administration, immédiatement après l’intervention chirurgicale, d’une seule dose de diclofénac (suppositoire de 100 mg) à des femmes qui ont subi une césairenne basse (CB) sous anesthésie rachidienne et péridurale combinée (ARPC) et qui ont reçu une analgésie péridurale autocontrôlée (APAC) postopératoire aved de la provicacaïne à 0,2 % et 2 µg·ml−1 de fentanyl.

Méthode: Quarante-huit parturientes d’état physique ASA I ou II, admises pour une CB planifiée sous anesthésie régionale ont été r réparties de façon aléatoire pour participer à une étude en double aveugle. Le programme d’analgésie péridurale autocontrôlée comprenait l’administration d’un bolus de 4 ml d’un mélange d’anesthésique local, suivie d’une période réfractaire de dix minutes, selon une limite de 12 ml à l’heure et sans perfusion de départ. La première demande d’analgésie postopératoire marquait le début e l’étude. Une, 6, 12 et 24 h après l’opération, on détermine les scores de douleur au mouvement, le niveau du bloc sensitif, le degré du bloc moteur et le volume d’anesthésique loal employé. À la fin de l’étude, on enregistre les scores de satisfaction des patientes.

Résultats: Les données personnelles des patientes des deux groups étaient similaires. Les patientes qui ont reçu un suppositoire de diclofénac ont utilisé 52,8±17,8 ml du mélange d’anesthésique local tandis que les autres en ont utilisé 74±25 ml (P <0,005). Les scores de douleur et de satisfaction n’ont pas présenté de différence integroupe significative.

Conclusion: L’administration d’un seul suppositoire de 100 mg de diclofénac réduit de façon efficace les besoins post-césarienne d’anesthésique local péridural/d’opioïde de 33 % pendant les 24 premières heures postopératoires.

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Author information

Correspondence to Noelle Louis Siew Hu Lim MBBS M Med (anaes).

Additional information

Research was carried out at Kandang Kerbau Women’s and Children’s Hospital, Singapore.

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Lim, N.L.S.H., Lo, W.K., Chong, J.L. et al. Single dose diclofenac suppository reduces post-Cesarean PCEA requirements. Can J Anesth 48, 383 (2001). https://doi.org/10.1007/BF03014968

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Keywords

  • Fentanyl
  • Bupivacaine
  • Ropivacaine
  • Motor Block
  • Motor Blockade