Diclofenac suppository versus intramuscular pethidine in post herniorrhaphy pain relief

Non-steroidal anti-inflammatory drugs (NSADs) and opioids are
frequently administered to relieve postoperative pain. Uncontrolled postoperative pain
may produce a range of detrimental acute and chronic health consequences and
increase mortality and morbidity. Practically, the analgesic efficacy of opioids is
typically limited by the development of tolerance to them or by opioid-related sideeffects
such as nausea, vomiting, sedation or respiratory depression. This study aims to
assess the effects of suppository diclofenac on post-herniorrhaphy pain management.
Methods: In this prospective double-blind clinical trial, 60 patients who were candidate
for the surgical repair of inguinal hernia were divided into two groups. Patients in
group A received 100 mg of suppository diclofenac and patients in group B 50 mg of
pethidine after the induction of anesthesia and before surgical incision. Postoperative
pain assessment was done by an unbiased observer on the arrival of patients in the
recovery room, using a 10-cm visual analogue scale (VAS) at 2-hour intervals for 6
hours.
Results: Pain relief was similar in the two groups (P=0.3). Patients in group B required
more analgesia two hours post-operatively (P=0.03), while patients in group A had more
favorable results regarding pain control (P<0.05). Statistically, there was no difference
between the two groups at other intervals. The occurrence of nausea and vomiting was
similar in both groups. No respiratory depression was observed in the patients.
Conclusion: Preventive analgesia with 100 mg of suppository diclofenac after
anesthesia induction for herniorrhaphy produced effective postoperative analgesia with
minimum side-effects