title: Opioid-sparing effects of diclofenac and paracetamol lead to improved outcomes after cardiac surgery.
abstract: OBJECTIVE
  This study assessed the analgesic efficacy, side effects, time to extubation, and oxygenation of 3 analgesic regimens after coronary artery bypass surgery using diclofenac, paracetamol, and placebo suppositories.
  
  
  METHODS
  Prospective, randomized, double-blind, placebo-controlled study.
  
  
  METHODS
  Referral center for cardiothoracic surgery at a university hospital.
  
  
  METHODS
  Sixty consenting adults scheduled for elective coronary artery bypass grafting (CABG).
  
  
  METHODS
  Patients were divided into 3 groups postoperatively: diclofenac/paracetamol: diclofenac, 100 mg rectally, and paracetamol, 1 g rectally. Diclofenac was repeated after 18 hours and paracetamol every 6 hours for 24 hours; diclofenac: diclofenac as in diclofenac/paracetamol, with placebos replacing paracetamol; and placebo: 2 placebo suppositories at same times as diclofenac/paracetamol. All patients received morphine patient-controlled analgesia.
  
  
  RESULTS
  Twenty-four hour morphine consumption with diclofenac/paracetamol was 12 +/- 6 mg, diclofenac 22 +/- 13 mg, and placebo 37 +/- 15 mg (diclofenac/paracetamol and diclofenac, p = 0.0003 and p = 0.0159 compared with placebo). Patients in the placebo group had significantly greater pain scores at 12 and 24 hours compared with diclofenac/paracetamol and diclofenac. Extubation time was significantly prolonged in the placebo group compared with the diclofenac/paracetamol and diclofenac groups (mean [SD] minutes diclofenac/paracetamol, diclofenac, and placebo 478 [150], 487 [257], and 710 [326], respectively). Oxygenation following extubation was significantly lower in the placebo group compared with the diclofenac/paracetamol and diclofenac groups (mean [SD] mmHg: diclofenac/paracetamol, diclofenac, and placebo 175 [44], 157 [43], and 117 [22], respectively). Episodes of nausea and vomiting were significantly less in the diclofenac/paracetamol and diclofenac groups than in the placebo group (46% and 51% reduction, respectively). all groups had similar blood loss and change in serum creatinine.
  
  
  CONCLUSIONS
  Diclofenac alone or with paracetamol has a significant opioid-sparing effect after CABG, producing more rapid extubation and better oxygenation.
authors.affiliation: Department of Anaesthesia, University Hospital of Wales, Cardiff, United Kingdom. fayaz94@hotmail.com
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Fayaz
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Abel
authors.forename: Steve C
authors.initials: SC
authors.lastname: Pugh
authors.forename: Judith E
authors.initials: JE
authors.lastname: Hall
authors.forename: George
authors.initials: G
authors.lastname: Djaiani
authors.forename: John S
authors.initials: JS
authors.lastname: Mecklenburgh
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000379:methods*; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013488:Suppositories; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac; D000082:Acetaminophen