When should diclofenac be given in ambulatory surgery: preoperatively or postoperatively?

Area of Science:

• Orthopedic Surgery
• Pain Management
• Pharmacology

Background:

• Ambulatory knee arthroscopy is a common procedure.
• Effective pain management is crucial for patient recovery and satisfaction.
• Optimizing the timing of non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac can enhance postoperative analgesia.

Purpose of the Study:

• To compare the efficacy of preoperative versus postoperative diclofenac administration for pain control in patients undergoing ambulatory knee arthroscopy.
• To determine the optimal timing for diclofenac administration to maximize pain relief and minimize opioid consumption.

Main Methods:

• A randomized, double-blind study involving 127 patients (ASA physical status I and II) undergoing ambulatory knee arthroscopy.
• Patients were divided into three groups: preoperative diclofenac, combined preoperative and postoperative diclofenac, and postoperative diclofenac.
• Pain was assessed using a visual analog scale (VAS) and fentanyl consumption via patient-controlled analgesia (PCA) was recorded.

Main Results:

• No significant differences in pain scores (at rest or during movement) were observed among the three groups.
• Fentanyl consumption through PCA did not differ significantly between patients receiving diclofenac preoperatively, postoperatively, or both.
• Both preoperative and postoperative administration of diclofenac potassium proved equally effective in managing pain.

Conclusions:

• The timing of diclofenac administration (preoperative vs. postoperative) does not influence pain relief in patients undergoing unilateral ambulatory knee arthroscopy.
• Diclofenac potassium is equally effective whether administered before or after surgery for pain management in this patient population.