title: The comparative effects of transdermal and intramuscular diclofenac on postlaparoscopic surgery pain.
abstract: OBJECTIVE
  Postlaparoscopic surgery pain management can reduce the discharge and recovery time. Thus conventional nonsteroidal anti-inflammatory drugs and opioids have been used for this purpose. The aim of this trial was to compare the analgesic and opioid-sparing efficacy of diclofenac sodium intramuscular (IM) with diclofenac transdermal patch in the management of postlaparoscopy pain.
  
  
  METHODS
  Patients were randomized to receive IM diclofenac 75 mg (n=30) 15 minutes before anesthesia or transdermal diclofenac (n=30) 3 hours before laparoscopic surgery. Transdermal or IM diclofenac were reapplied 12 hours later. All patients were administered tramadol intravenously before surgery. Postoperative pain management was maintained with tramadol using a patient-controlled analgesia device. Postoperative visual analogue pain scores (VAS, 0 to 10 cm) and adverse reactions were recorded over a 24-hour period. If VAS values were >4, 25 mg tramadol was given intravenously as a rescue analgesic.
  
  
  RESULTS
  In both groups, VAS scores were higher in the first 4 hours. There were no significant differences in postoperative pain between the 2 groups. The postoperative tramadol consumption, and rescue analgesic needs of the patients between both groups were not statistically significant. Injection pain was observed in the IM diclofenac group, but for both groups no skin reactions were observed at the application sites of the drugs.
  
  
  CONCLUSIONS
  Diclofenac transdermal patch provided pain relief for postoperative laparoscopic surgery as effectively as IM diclofenac and can be used.
authors.affiliation: Department of Anesthesiology, Fatih University Faculty of Medicine, Ankara, Turkey. drsafinaz@yahoo.com
authors.forename: Safinaz
authors.initials: S
authors.lastname: Karabayirli
authors.forename: Rüveyda Irem
authors.initials: RI
authors.lastname: Demircioğlu
authors.forename: Bünyamin
authors.initials: B
authors.lastname: Muslu
authors.forename: Burhanettin
authors.initials: B
authors.lastname: Usta
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Sert
authors.forename: Muhammet
authors.initials: M
authors.lastname: Gözdemir
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D004008:Diclofenac / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011446:Prospective Studies; D014147:Tramadol / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D004008:Diclofenac; D014147:Tramadol