The efficacy and safety of intramuscular aceclofenac and diclofenac for managing postoperative pain in patients undergoing composite resection for oral cancer

Abstract

Aim: Non-steroidal anti-inflammatory drugs are the most used analgesics for postoperative pain management. Aceclofenac is a newer phenylacetic acid derivative, and being a predominant cyclooxygenase-2 inhibitor, it has better gastrointestinal tolerability than diclofenac. The aim was to compare the efficacy and safety of aceclofenac and diclofenac in managing postoperative pain using the Face Legs Activity Cry Consolability (FLACC) score and a visual analog scale (VAS) following composite resection for oral cancer. Methods: Seventy-six patients who underwent composite resection for oral cancer at a tertiary care hospital were randomly assigned to receive either injection of aceclofenac 150 mg or diclofenac 75 mg intramuscularly at 0, 12, 24, 36, 48, and 60 h postoperatively. The FLACC score was recorded at 2, 4, 8, 12, and 24 h, and the VAS score was recorded at 24, 36, 48, 60, and 72 h. Intravenous tramadol 100 mg was given as a rescue analgesic if the FLACC or VAS score was > 3. The patient satisfaction score was recorded at 72 h. Results: There were 61 female and 15 male patients. Mean surgery durations in the aceclofenac and diclofenac groups were 450.00 ± 116.00 and 416.84 ± 130.63 minutes, respectively. Mean FLACC scores between the two groups were not significantly different. Patients receiving diclofenac had significantly lower mean VAS scores (P = 0.005) at 72 than at 24 h. There was no significant difference in mean VAS scores between groups. The amount of rescue analgesic required in both groups was similar (P = 0.34). At 72 h, 31.57% of patients graded their satisfaction as good in the aceclofenac group and 34.21% in the diclofenac group. Nausea and dyspepsia were common adverse effects in both groups. Conclusion: Aceclofenac was as effective as diclofenac in reducing postoperative pain following composite resection for oral cancer. In individuals with a history of gastritis or peptic ulcer, aceclofenac can be an alternative to diclofenac.