Nishef Adhikari, Sidra Shoaib Qureshi, Ahmad Uzair Qureshi, Muhammad Shahid Farooq, Abrar Ashraf Ali.
Efficacy of pre-operative rectal diclofenac suppository for postop pain management in laparoscopic cholecystectomy: a multicenter prospective randomized controlled trial.
Pak J Med Health Sci Jan ;13(4):890-3.

Background : Laparoscopic procedures have gained popularity owing to reduction in pain suffered due to large incisions in conventional open procedures, minimally invasive approaches is not absolutely pain free. Aim : To compare the effectiveness of pre -operative rectal diclofenac suppository (single dose) among patients operated for laparoscopic cholecystectomy (LC). Methods: 63 patients were randomized into two groups. Single dose 100 mg Diclofenac suppository was placed perrectally at the time of induction and standard 4 –port laparoscopic cholecystectomy was done. Postoperative pain scores were recorded on a visual analogue score and results analyzed. Results: Both groups were comparable in term of age (36.87±12.52 & 36.93±10.05 years) (p=0.982), BMI (27.63±1.77Kg /m 2 & 27.73±1.73Kg/m 2) and operative time between two groups (P= 0.854). Significant difference in pain score between two groups was observed during zero, three, six, nine and 12 hours of post-operative observation. Conclusion: Pre-operative use of Diclofenac suppository significantly reduced post-operative pain scores and should be used in all patients planned for laparoscopic cholecystectomy. There is an added benefit that the group can be used safely in patients with acid pep tic disease.

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