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The Effect of Diclofenac on Bleeding, Platelet Function, and Consumption of Opioids Following Cardiac Surgery
Irena Osojnik1, Mirt Kamenik1,2
1University Medical Centre Maribor Intensive Care and Pain Management Department of Anaesthesiology Maribor Slovenia Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia.
Insights
Diclofenac did not reduce opioid use or bleeding in patients after coronary artery bypass grafting (CABG) surgery. However, diclofenac may reduce inflammation, suggesting it could be safe for CABG patients despite not impacting opioid consumption.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) often requires significant postoperative pain management, typically involving opioids.
- Non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac are considered for analgesia but their impact on bleeding and opioid use post-CABG needs clarification.
Purpose of the Study:
- To evaluate the efficacy of diclofenac in reducing opioid administration after CABG surgery.
- To assess the effects of diclofenac on bleeding and platelet function following CABG with cardiopulmonary bypass (CPB).
Main Methods:
- A retrospective randomized study involving 72 patients undergoing CABG surgery.
- Patients were divided into two groups: one receiving diclofenac and a control group.
- Opioid consumption (piritramide), blood loss, and platelet function were measured 20 hours post-surgery.
Main Results:
- No significant difference in piritramide consumption between the diclofenac and control groups (26±8 mg vs. 28±8 mg).
- No significant differences in blood loss or platelet function were observed between the groups.
- C-reactive protein (CRP) levels were significantly lower in the diclofenac group (33±15 mg/L vs. 46±22 mg/L, P<0.05).
Conclusions:
- Diclofenac administration did not lead to reduced opioid consumption or associated symptoms in patients post-CABG.
- Diclofenac, at clinically used doses, appears safe regarding platelet function and bleeding risk after CABG.
- Lower CRP levels suggest diclofenac might mitigate the inflammatory response following cardiopulmonary bypass, warranting further investigation into its role in CABG pain management.
Objective:
To establish whether the use of diclofenac reduces the administration of opioids and how it affects bleeding and platelet function after the coronary artery bypass grafting (CABG) surgery with use of cardiopulmonary bypass (CPB).
Methods:
A total of 72 patients undergoing CABG surgery were included in this retrospective randomized study and divided into two groups (34 patients received diclofenac and the control group of 38 patients did not). For postoperative analgesia, both groups were prescribed opioids (piritramide). The primary endpoint was to establish the consumption of opioids. The secondary endpoint was to determine bleeding and the function of platelets 20 hours after the surgery.
Results:
The consumption of piritramide (diclofenac group 26±8 mg vs. control group 28±8 mg), the blood loss, and the function of platelets did not significantly differ between the groups within 20 hours after surgery. C-reactive protein (CRP) was statistically significantly lower in the diclofenac group than in the control group (33±15 mg/L vs. 46±22 mg/L, respectively, P<0.05).
Conclusion:
The study concluded that patients administered with diclofenac after the heart surgery did not consume less opioid analgesics and did not exhibit less symptoms linked to the consumption of opioids. Diclofenac in clinically administered doses does not interfere with the function of platelets and does not cause increased bleeding. Lower CRP in the diclofenac group may indicate a reduced inflammatory response after CPB. Therefore, diclofenac could be safe for use in patients undergoing CABG surgery but its value in reducing opioid consumption should be questioned.
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