Karabayirli Safinaz, Demircioğlu Rüveyda Irem, Muslu Bünyamin, Usta Burhanettin, Sert Hüseyin, Gözdemir Muhammet
Department of Anesthesiology, Fatih University Faculty of Medicine, Ankara, Turkey.
Surg Laparosc Endosc Percutan Tech. 2012 Aug;22(4):374-8. doi: 10.1097/SLE.0b013e31825b2b76.
Postlaparoscopic surgery pain management can reduce the discharge and recovery time. Thus conventional nonsteroidal anti-inflammatory drugs and opioids have been used for this purpose. The aim of this trial was to compare the analgesic and opioid-sparing efficacy of diclofenac sodium intramuscular (IM) with diclofenac transdermal patch in the management of postlaparoscopy pain.
Patients were randomized to receive IM diclofenac 75 mg (n=30) 15 minutes before anesthesia or transdermal diclofenac (n=30) 3 hours before laparoscopic surgery. Transdermal or IM diclofenac were reapplied 12 hours later. All patients were administered tramadol intravenously before surgery. Postoperative pain management was maintained with tramadol using a patient-controlled analgesia device. Postoperative visual analogue pain scores (VAS, 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS values were >4, 25 mg tramadol was given intravenously as a rescue analgesic.
In both groups, VAS scores were higher in the first 4 hours. There were no significant differences in postoperative pain between the 2 groups. The postoperative tramadol consumption, and rescue analgesic needs of the patients between both groups were not statistically significant. Injection pain was observed in the IM diclofenac group, but for both groups no skin reactions were observed at the application sites of the drugs.
Diclofenac transdermal patch provided pain relief for postoperative laparoscopic surgery as effectively as IM diclofenac and can be used.
腹腔镜手术后的疼痛管理可缩短出院时间和恢复时间。因此，传统的非甾体抗炎药和阿片类药物已用于此目的。本试验的目的是比较双氯芬酸钠肌肉注射（IM）与双氯芬酸透皮贴剂在腹腔镜手术后疼痛管理中的镇痛和节省阿片类药物的疗效。
患者被随机分为两组，一组在麻醉前15分钟接受75毫克双氯芬酸肌肉注射（n = 30），另一组在腹腔镜手术前3小时接受双氯芬酸透皮贴剂（n = 30）。12小时后重新应用透皮或肌肉注射双氯芬酸。所有患者在手术前静脉注射曲马多。术后使用患者自控镇痛装置用曲马多维持疼痛管理。在24小时内记录术后视觉模拟疼痛评分（VAS，0至10厘米）和不良反应。如果VAS值>4，则静脉注射25毫克曲马多作为急救镇痛药。
两组在前4小时的VAS评分均较高。两组术后疼痛无显著差异。两组患者术后曲马多的消耗量和急救镇痛需求无统计学意义。在双氯芬酸肌肉注射组中观察到注射疼痛，但两组在药物应用部位均未观察到皮肤反应。
双氯芬酸透皮贴剂在腹腔镜手术后的疼痛缓解方面与双氯芬酸肌肉注射同样有效，可予使用。
