Diclofenac suppository vs. IV acetaminophen combined with IV PCA for postoperative pain management in patients undergoing laminectomy: A randomized, double-blinded clinical trial

Abstract

Background: Tissue damage caused by surgical procedures nearly always results in pain. The effective management of postoperative pain remains a challenge because of its influence on the surgical outcome and its critical role in early mobilization and functionality. Recent research on postoperative pain management supports a treatment approach known as "multimodal analgesia," which comprises the use of more than one method or modality of pain control and management. Objectives: In the present study, we compared the effects of diclofenac suppository and intravenous (IV) acetaminophen combined with IV patient-controlled analgesia (PCA) for pain management after laminectomy surgery. Patients and Methods: Our randomized, double-blinded controlled trial during 2013 at Besat hospital in Hamadan, Iran, included 102 ASA I-II patients aged 18 to 65 years who were candidates for laminectomy surgery. The patients were randomly assigned to receive the diclofenac suppository (100 mg) (n = 51) or IV acetaminophen (1 g in 100 mL normal saline) (n = 51) 10 minutes before completing surgery and 12 hours after the operation. Results: The patients’ characteristics were the same in both study groups. The patients’ satisfaction levels were higheramongthose who received diclofenac when compared with the acetaminophen group, especially at the time points of 6 and 12 h after surgery. The consumed narcotic using the PCA pump within 24 h of surgery in the diclofenac group was significantly lower than that of the acetaminophen group (735.70±59.61 µg vs. 819.70±80.02 µg; P < 0.001). Conclusions: The use of diclofenac suppositorycombined with IV PCAresults in reduced narcotic usageanda higher level of patient satisfaction compared to the use of IV acetaminophen combined with IV PCA.