title: Effect of intramuscular diclofenac after explore laparotomy for gynecologic surgery: a randomized double-blinded placebo controlled trial.
abstract: BACKGROUND
  Several adjuvant analgesic agents proposed to treat the postoperative pain while reducing the doses of opioid and its derivatives. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in several operative procedures. The present study aimed to demonstrate the morphine-sparing effects of single-dose intramuscular diclofenac sodium in explore laparotomy gynecologic surgery.
  
  
  METHODS
  Forty-six patients were randomly assigned to receive 75-mg of diclofenac sodium or normal saline with intramuscular morphine during immediate postoperative period. Additional morphine for pain control was given by patient-controlled analgesia. 24-hour morphine consumption, pain score, adverse effects and satisfaction of the patients were recorded.
  
  
  RESULTS
  Median morphine consumption among groups was significant difference between placebo and diclofenac group (32 and 19 mg) (p = 0.041). Greater difference was shown in patients who underwent total abdominal hysterectomy (p = 0.009). Catagorical pain score at 6-hour postoperatively was significant lower in diclofenac group (p = 0.006). No significant difference was found between groups in visual analogue pain score, patients' satisfaction, presence of bleeding or nausea and vomiting.
  
  
  CONCLUSIONS
  The present study demonstrated that single dose of diclofenac sodium has morphine-sparing effects and can be safely used in explore laparotomy gynecologic surgery without significant adverse effects.
authors.affiliation: Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. yuthadej06@yahoo.com
authors.forename: Yuthadej
authors.initials: Y
authors.lastname: Thaweekul
authors.forename: Komsun
authors.initials: K
authors.lastname: Suwannarurk
authors.forename: Karicha
authors.initials: K
authors.lastname: Maireang
authors.forename: Yenrudee
authors.initials: Y
authors.lastname: Poomtavorn
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007273:Injections, Intramuscular; D007813:Laparotomy / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D004008:Diclofenac; D009020:Morphine