Malik Mohammad Khalid, Maratib Ali, Lubna Habib, Ataur Rahman.
Pre emptive analgesic efficacy of diclofenac sodium in orthopaedic surgery.
J Pak Orthop Assoc Jan ;21(1):50-4.

Objective: To evaluate the effectiveness of intramuscular Diclofenac sodium for the pain free post operative period when started as pre emptive analgesic agent in orthopaedic patients. Design & Duration: Prospective clinical trial conducted on 60 patients from September 2008 to February 2009. Setting: Orthopaedic unit II of Civil Hospital, Karachi. Patients: All consecutive patients who were operated upon for internal fixation of fractures and for the management of soft tissue injury were included. Patients with acid peptic disease, renal failure, asthma and inflammatory bowel disease were excluded from the study. 30 patients were selected randomly in whom Diclofenac sodium as intramuscular injection was given half an hour before the start of procedure as pre emptive analgesia (Group I). Rest of 30 patients did not receive any analgesia before procedure (Group II). All patients were kept on fixed dose of Diclofenac sodium 12 hourly post operatively. Nalbuphine was used as rescue analgesia. Pain was assessed at regular intervals of 6th, 12th, 18th and 24th hour of surgery using Visual Analog Scale (VAS). The additional requirement of Nalbuphine and any side effect of Diclofenac sodium were recorded. Result: Pain assessment using visual analog scale in both groups at regular interval showed significant reduction in post operative pain in group I in whom pre emptive analgesia was given (p value approx. 0). Pre emptive analgesia reduced the requirement of rescue analgesic in group I. Both groups were not different significantly in respect to safety of Diclofenac sodium. Out of 60 patients 7 (11.66%) patients developed epigastric pain, 4 from group I and 3 in group II.

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