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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1999 October;65(10):741-5

language: English

Effects of diclof­e­nac and ­intra-artic­u­lar mor­phine/bupiv­a­caine on post­ar­thros­cop­ic ­pain con­trol

Gurkan Y. 1, Kilickan L. 1, Buluc L. 2, Muezzinoglu S. 2, Toker K. 1

1 Department of Anaesthesiology and Reanimation, Kocaeli University Hospital, Kocaeli, Turkey;
2 Department of Orthopaedics Surgery, Kocaeli University Hospital, Kocaeli, Turkey


Background. This ­study was under­tak­en to com­pare anal­ge­sic ­effects and require­ments for sup­ple­men­tal anal­ge­sic ther­a­py ­after ­knee arthros­co­py in ­patients giv­en intra­ar­tic­u­lar mor­phine/bupiv­a­caine, diclof­e­nac i.m., or ­both com­pared ­with pla­ce­bo.
Method. In a ran­dom­ised, dou­ble-­blind con­trolled ­trial 40 ­patients ­were divid­ed ­into ­four ­groups. Patients ­received 25 ml of 0.25% bupiv­a­caine and 2 mg of mor­phine intra­ar­tic­u­lar­ly in ­group I, 75 mg of diclof­e­nac i.m. in ­group III, the com­bi­na­tion of 75 mg of diclof­e­nac i.m. and 25 ml of 0.25% bupiv­a­caine and 2 mg of mor­phine intra­ar­tic­u­lar­ly in ­group II, and pla­ce­bo in ­group IV. Postoperative anal­ge­sia was pro­vid­ed ­with fen­ta­nyl in the recov­ery ­room and ace­tam­i­no­phen was giv­en for sub­se­quent ­pain ­relief.
Results. In the post­op­er­a­tive peri­od, VAS ­scores for ­pain ­were high­est in the pla­ce­bo ­group, where­as they were low­est in the com­bi­na­tion ­group. VAS ­scores ­were sig­nif­i­cant­ly low­er in ­group I and II ­than ­group IV at the post­op­er­a­tive 2nd ­hour (p<0.05). VAS ­score was sig­nif­i­cant­ly low­er in ­group II ­than ­groups III and IV at the post­op­er­a­tive 3rd ­hour (p<0.01). VAS ­scores ­were sig­nif­i­cant­ly low­er in ­group I, II and III ­than ­group IV at the post­op­er­a­tive 6th ­hour (p<0.05). Fentanyl con­sump­tion was sig­nif­i­cant­ly low­er in ­group II ­than ­group IV (p<0.05). Acetamino-phen con­sump­tion in ­groups II and III ­were sig­nif­i­cant­ly low­er ­than ­group IV (p<0.05).
Conclusion. The com­bi­na­tion of diclof­e­nac i.m. and intra­ar­tic­u­lar mor­phine/bupiv­a­caine ­appears to be the ­most ben­e­fi­cial anal­ge­sic com­bi­na­tion due to its low­er VAS ­scores and sup­ple­men­tal anal­ge­sic require­ments in the post­op­er­a­tive peri­od.

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