title: Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective cesarean delivery.
abstract: BACKGROUND
  Postoperative pain mostly results from sensitization of afferent fibers at injury sites driving central sensitization. Recently, peripheral processes have gained attention as mechanisms of hyperalgesia, and prostaglandins are among highly sensitizing agents. To date, perioperative administration of a single local dose of nonsteroidal antiinflammatory drugs has shown inconclusive efficacy. Rather than a single bolus, the current study evaluates the postoperative analgesic effect of diclofenac continuous intrawound infusion after elective cesarean delivery.
  
  
  METHODS
  Ninety-two parturients were randomly allocated to receive a 48-h continuous intrawound infusion with 240 ml containing 300 mg diclofenac, 0.2% ropivacaine, or saline. In the ropivacaine and saline groups, patients also received 75 mg intravenous diclofenac every 12 h for 48 h. Postoperative evaluation included intravenous morphine consumption by patient-controlled analgesia and visual analog pain scores. Punctate mechanical hyperalgesia surrounding the wound and presence of residual pain after 1 and 6 months were also assessed.
  
  
  RESULTS
  Continuous diclofenac infusion significantly reduced postoperative morphine consumption (18 mg; 95% confidence interval, 12.7-22.2) in comparison with saline infusion and systemic diclofenac (38 mg; 95% confidence interval, 28.8-43.7) (P=0.0009) without unique adverse effects. Postoperative analgesia produced by local diclofenac infusion was as effective as local ropivacaine infusion with systemic diclofenac.
  
  
  CONCLUSIONS
  After elective cesarean delivery, continuous intrawound infusion of diclofenac demonstrates a greater opioid-sparing effect and better postoperative analgesia than the same dose administered as an intermittent intravenous bolus.
authors.affiliation: Department of Anesthesiology, St. Luc Hospital Medical School, Université Catholique de Lovain, Brussels, Belgium. lavandhomme@anes.ucl.ac.be
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Lavand'homme
authors.forename: Fabienne
authors.initials: F
authors.lastname: Roelants
authors.forename: Hilde
authors.initials: H
authors.lastname: Waterloos
authors.forename: Marc F
authors.initials: MF
authors.lastname: De Kock
mesh_terms: D000328:Adult; D000577:Amides; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002585:Cesarean Section; D004008:Diclofenac / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006930:Hyperalgesia; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D000077212:Ropivacaine