Peri-operative administration of rectal diclofenac sodium. The effect on renal function in patients undergoing minor orthopaedic surgery.
In a randomized, double-blind study, we administered placebo and diclofenac sodium 100 mg suppositories 1 h pre-operatively and on the first post-operative morning to 22 adult patients undergoing minor orthopaedic surgery. A standardized post-operative intravenous fluid regimen was instituted until oral fluids were tolerated. Renal function was assessed pre-operatively, and on the first and second post-operative days by the measurement of urine output, creatinine, urea, sodium, potassium and NAG (N-acetyl-b-D-glucosaminidase) levels and serum creatinine, urea, sodium and potassium concentrations. On the first post-operative day, the diclofenac group demonstrated a reduced urinary sodium excretion. On the second post-operative day, a reduced urinary NAG/creatinine ratio was observed in the diclofenac group when compared to placebo. We conclude that peri-operative administration of diclofenac causes changes in renal function consistent with prostaglandin inhibition on the first post-operative day but had no lasting adverse effects in this group of patients. Our results reinforce the need for caution when administering this drug in the context of pre-existing renal impairment.
Irwin
M G
MG
Department of Anaesthesiology, University of Hong Kong, Hong Kong.
Roulson
C J
CJ
Jones
R D
RD
Cheng
I K
IK
Visram
A R
AR
Chan
Y M
YM
D000118:Acetylglucosaminidase / Q000652:urine; D000285:Administration, Rectal; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000494:pharmacology; D001842:Bone and Bones / Q000601:surgery*; D003404:Creatinine / Q000097:blood / Q000652:urine; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D004008:Diclofenac / Q000008:administration & dosage* / Q000494:pharmacology; D004311:Double-Blind Method; D005440:Fluid Therapy; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D013511:Minor Surgical Procedures; D010919:Placebos; D011182:Postoperative Care; D011188:Potassium / Q000097:blood / Q000652:urine; D011292:Premedication; D011448:Prostaglandin Antagonists / Q000008:administration & dosage* / Q000494:pharmacology; D012964:Sodium / Q000097:blood / Q000652:urine; D013488:Suppositories; D014508:Urea / Q000097:blood / Q000652:urine; D014554:Urination / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D010919:Placebos; D011448:Prostaglandin Antagonists; D013488:Suppositories; D004008:Diclofenac; D014508:Urea; D012964:Sodium; D003404:Creatinine; D000118:Acetylglucosaminidase; D011188:Potassium