The preemptive use of diclofenac sodium in combination with ketamine and remifentanil does not enhance postoperative analgesia after laparoscopic gynecological procedures.

OBJECTIVE To evaluate the preemptive effects of diclofenac sodium, in combination with remifentanil and ketamine. METHODS A prospective, randomized, double blind, placebo-controlled trial was carried out at the Hacettepe University Hospital, Ankara, Turkey from September to December 2004. Forty-three, American Society of Anesthesiology physical status group I-II women, aged >18 years, who would undergo both diagnostic and operative laparoscopic surgery were randomly assigned into 2 groups. All patients received intraoperative 0.1 microg x kg(-1)min(-1) remifentanil infusion. Diclofenac (1 mg x kg(-1) intramuscular) was administered, 20 minutes before the operation. Ketamine (0.8 mg x kg(-)1 intravenously) was administered 5 minutes before the skin incision and at completion of skin closure. We divided the patients into 2 groups; Group I (diclofenac + remifentanil + ketamine), Group II (remifentanil + ketamine). Pain was evaluated postoperatively using the visual analogue scale (VAS) while global satisfaction by verbal rating scale (VRS). RESULTS All 43 female patients have a mean +/- SD age of 32.3 +/- 6.5 years, height of 163 +/- 5.3 cm, and weight of 62.9 +/- 9.5 kg. The VAS and VRS scores and also time to first analgesic request were not different between the groups. In all groups, >98% of the patients were satisfied or very satisfied. CONCLUSION We have not found any preemptive or additive effect of diclofenac sodium with the concomitant use of ketamine.

[1]  P. White.  The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain , 2005, Anesthesia and analgesia.

[2]  M. Annetta,et al.  Ketamine: new indications for an old drug. , 2005, Current drug targets.

[3]  E. Wuolijoki,et al.  Effective postoperative pain control by preoperative injection of diclofenac , 2004, European Journal of Clinical Pharmacology.

[4]  P. Glass,et al.  Effective analgesic modalities for ambulatory patients. , 2003, Anesthesiology clinics of North America.

[5]  H. EL-FATTAH,et al.  Ketamine reduces swallowing‐evoked pain after paediatric tonsillectomy , 2003, Acta anaesthesiologica Scandinavica.

[6]  T. Gan,et al.  Comparison of the morphine-sparing effects of diclofenac sodium and ketorolac tromethamine after major orthopedic surgery. , 2002, Journal of clinical anesthesia.

[7]  M. Silvanto,et al.  Comparison of the opioid‐sparing efficacy of diclofenac and ketoprofen for 3 days after knee arthroplasty , 2002, Acta anaesthesiologica Scandinavica.

[8]  J. Corcuff,et al.  Fentanyl Enhancement of Carrageenan-induced Long-lasting Hyperalgesia in Rats: Prevention by the N-methyl-d-aspartate Receptor Antagonist Ketamine , 2002, Anesthesiology.

[9]  F. Chung,et al.  Multimodal analgesia for postoperative pain control. , 2001, Journal of clinical anesthesia.

[10]  M. Kock,et al.  ‘Balanced analgesia’ in the perioperative period: is there a place for ketamine? , 2001, PAIN®.

[11]  E. Bradley,et al.  The Effect of Ketamine on Opioid-Induced Acute Tolerance: Can It Explain Reduction of Opioid Consumption with Ketamine-Opioid Analgesic Combinations? , 2000, Anesthesia and analgesia.

[12]  F. Guirimand,et al.  The Benefits of Intraoperative Small-Dose Ketamine on Postoperative Pain After Anterior Cruciate Ligament Repair , 2000, Anesthesia and analgesia.

[13]  A. Sandler,et al.  Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes , 1999, Pain.

[14]  T. Fuhrman,et al.  Small-dose ketamine enhances morphine-induced analgesia after outpatient surgery. , 1999, Anesthesia and analgesia.

[15]  A. Shigematsu,et al.  Ketamine suppresses proinflammatory cytokine production in human whole blood in vitro. , 1999, Anesthesia and analgesia.

[16]  D. Rowbotham,et al.  The effect of pre‐incisional infiltration with lignocaine on postoperative pain after molar teeth extraction under general anaesthesia , 1996, Anaesthesia.

[17]  M. Zacharias,et al.  Effectiveness of preoperative analgesics on postoperative dental pain: a study. , 1996, Anesthesia progress.

[18]  B. T. Sitzman,et al.  Pre-emptive versus post-surgical administration of ketorolac for hysterectomy. , 1995, European journal of anaesthesiology.

[19]  T. Gin,et al.  A comparison between ketorolac and diclofenac in laparoscopic sterilization. , 1995, European journal of anaesthesiology.

[20]  M. Higgins,et al.  Recovery from outpatient laparoscopic tubal ligation is not improved by preoperative administration of ketorolac or ibuprofen. , 1994, Anesthesia and analgesia.

[21]  D. Se,et al.  Lack of efficacy of ketorolac tromethamine for analgesia on patients undergoing colonoscopy. , 1993 .

[22]  S. Deal,et al.  Lack of efficacy of ketorolac tromethamine for analgesia on patients undergoing colonoscopy. , 1993, The American journal of gastroenterology.

[23]  B. Kavanagh,et al.  Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. , 1992, Anesthesiology.

[24]  H. Kehlet,et al.  Influence of timing on the effect of continuous extradural analgesia with bupivacaine and morphine after major abdominal surgery. , 1992, British journal of anaesthesia.

[25]  S. K. Anderson,et al.  Diclofenac in combination with opiate infusion after joint replacement surgery. , 1992, Anaesthesia and intensive care.

[26]  H. Schaible,et al.  The Effects of NMDA Antagonists on Neuronal Activity in Cat Spinal Cord Evoked by Acute Inflammation in the Knee Joint , 1991, The European journal of neuroscience.

[27]  T. Tammisto,et al.  Efficacy of diclofenac in a single prophylactic dose in postoperative pain. , 1987, Annals of clinical research.