title: The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal, oral and intramuscular, in early postoperative period in laparoscopic cholecystectomy operations.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption.
  
  
  METHODS
  Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete's Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded.
  
  
  RESULTS
  Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported.
  
  
  CONCLUSIONS
  In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment.
authors.affiliation: Sedef Gulcin Ural, Department of Anesthesiology and Reanimation, Ankara Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
authors.forename: Sedef
authors.initials: S
authors.lastname: Gulcin Ural
authors.affiliation: Ozlem Yener, Department of Radiology, Ankara Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yener
authors.affiliation: Hasan Sahin, Department of Anesthesiology and Reanimation, Medical Faculty, Canakkale Onsekiz Mart University, Canakkale, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Sahin
authors.affiliation: Tuncer Simsek, Department of Anesthesiology and Reanimation, Medical Faculty, Canakkale Onsekiz Mart University, Canakkale, Turkey.
authors.forename: Tuncer
authors.initials: T
authors.lastname: Simsek
authors.affiliation: Bahar Aydinli, Department of Anesthesiology and Reanimation, Ankara Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Aydinli
authors.affiliation: Aysegul Ozgok, Department of Anesthesiology and Reanimationm Ankara Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Ozgok
keywords: Diclofenac sodium; Laparoscopic cholecystectomy; Postoperative pain; Tramadol; Transdermal