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Diclofenac premedication, as the effect of preventive anelgesia after post thoracotomy/thoracoscopy pain, as well as the changes of the lung function test values

Background

Preventive analgesia is defined as administration of analgetics or nerve blockade before the surgical procedure. As a result of the preventive antinociceptive treatment, the quantity of post-operative medications can be decreased, the analgesia has less complications and the patients are more satisfied [1,2].

In our study we intend to examine the preventive analgetic effect a single oral dose of diclofenac.

The hypothesis of the study is that preventive analgesia by single dose of diclofenac results in 25% decrease of the postoperative VAS scores as compared to the control group.

Key words: preventive, pain, analgesia

Patients and methods

One hundred and fifty-five patients were randomly allocated to two groups:

  • DICgroup: received a preoperative single oral 100 mg dose of diclofenac
  • CONgroup: without diclofenac premedication

We examined every patient for four days: we recorded the patients’ pain with the help of the Visual Analogue Scale (VAS). We also recorded the patients’ respiratory function with the help of MIR spirolab II spirometer in the postoperative setting.

Results

In patients who underwent thoracotomy there were no significant differences in cumulative bupivacaine dose (cBUC mg/kg) values of epidural administered drugs, neither in cumulative morphine equivalent dose (cMED mg/kg) of intravenously and per os administered drugs (p>0.05). There were no significant differences in cumulative VAS values in terms of thoracotomy pain, neither in cVAS values measured for shoulder pain (p>0.05).

Thoracotomy

(n=100)

cBUCed cMEDiv cMEDpo cVASth cVASsh
DICgroup

(n=50)

2.6

(2.2-3)

8.5

(1.6-30.7)

2.1

(0.8-3.7)

32

(25-43)

2

(0-12)

CONgroup

(n=50)

2.8

(2.4-3,5)

5.9

(2-38.5)

2.3

(1.4-3.7)

36

(29-46)

8

(0-16)

VATS

(n=55)

cBUCed cMEDiv cMEDpo cVASth cVASsh
DICgroup

(n=26)

1.9

(1.5-2.7)

1.9

(1.1-24.8)

2.1

(1.2-3)

32.5

(22-39)

5

(0-13)

CONgroup

(n=29)

2.1

(1.8-2.5)

2.9

(1.7-28.2)

1.5

(0.8-3.1)

34

(20.7-46)

10

(0-15.5)

Data is interpreted as median and interquartile range.

There were no significant differences in FEV1 values (%) between the two groups before, and after the operation with chest drain, and after the chest drain removal (p>0.05).

Thoracotomy

(n=100)

FEV1preop FEV1postopdrain FEV1postop
DICgroup

(n=50)

83.2±17.4 39.3±13.8 49.5±12.3
CONgroup

(n=50)

83.1±20.3 40.1±13.8 52.2±13.4
VATS

(n=55)

FEV1preop FEV1postopdrain FEV1postop
DICgroup

(n=26)

81±26.8 40±12.5 52.3±17.6
CONgroup

(n=29)

85.4±18.5 38.1±12.5 51.4±12.1

Data is interpreted as mean and standard deviation.

Conclusion

The use of the epidural administered drugs is so effective for the post operative pain control, that the premedication with 100 mg diclofenac can not cause significant change in VAS scores.

References

  1. Peter Gerner et al. Post-thoracotomy Pain Management Problems. Anaesthesiol Clin. 2008; 26(2):355.
  2. Senturk M. Acut and chronic pain after thoracotomies. Curr Opin Anaesthesiol. 2005; 18(1):1-4.

Balázs Pálóczi, Tamás Végh, Ágota Kazup, Farkas Orsolya, Parham Choromi

Supervisor: Béla Fülesdi1

Balázs Pálóczi, Tamás Végh, Ágota Kazup, Farkas Orsolya, Béla Fülesdi
Department of Anesthesiology and Intensive Care, University of Debrecen, 4032 Debrecen, Hungary

Parham Choromi
Department of Anesthesiology and Intensive Care, Hetényi Géza County Hospital, 5004 Szolnok, Hungary

Corresponding author's contact:
e-mail: paloczib82@gmail.com
Tel: 00-36-30-939-60-48

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