When should diclofenac be given in ambulatory surgery: preoperatively or postoperatively?
OBJECTIVE
To determine the optimum time of administration of diclofenac in patients undergoing ambulatory knee arthroscopy: either preoperatively or postoperatively.


METHODS
Randomized, double-blind study.


METHODS
Ambulatory surgical unit in a tertiary referral hospital.


METHODS
127 ASA physical status I and II patients undergoing ambulatory knee arthroscopy.


METHODS
Patients were randomized into three groups. The Preop group received 50 mg of potassium diclofenac orally 1 hour preoperatively and a placebo 30 minutes postoperatively. The Pre+postop group received 25 mg of potassium diclofenac 1 hour preoperatively and 25 mg diclofenac 30 minutes postoperatively. The Postop group received a placebo 1 hour before surgery and 50 mg of potassium diclofenac 30 minutes postoperatively.


RESULTS
The Postop group received a placebo 1 hour preoperatively and 50 mg of potassium diclofenac 30 min postoperatively. Postoperatively, patients used intravenous patient-controlled analgesia (PCA) with fentanyl. Total fentanyl consumption was recorded. During the recovery period, pain was assessed using a visual analog scale (VAS) at 30-minute intervals. Pain was assessed in both legs at rest, on flexion, and extension of the knee. There were no significant differences in pain scores either at rest or on movement of the operative knee among the Preop, Pre+postop, and Postop groups. The consumption of fentanyl via PCA showed no significant differences among the groups.


CONCLUSIONS
There is no difference in pain relief whether diclofenac is given preoperatively or postoperatively in patients undergoing unilateral ambulatory knee arthroscopy. Preoperative and postoperative treatment with diclofenac potassium is equally effective.
Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
A
A
Norris
V
V
Un
F
F
Chung
S
S
Thanamayooran
A
A
Sandler
J
J
Katz
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000627:therapeutic use*; D001182:Arthroscopy; D004008:Diclofenac / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control* / Q000523:psychology; D011184:Postoperative Period; D011300:Preoperative Care
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac