title: Diclofenac is more effective for post-operative analgesia in patients undergoing lower abdominal gynecological surgeries: A comparative study.
abstract: OBJECTIVE
  The present study aimed to compare the efficacy of injectable diclofenac intramuscularly (IM), injection paracetamol intravenously (IV), or a combination of both to provide post-operative analgesia in patients undergoing lower abdominal gynecological surgeries.
  
  
  METHODS
  A total of 90 female patients (American Society of Anesthesiologists I and II), aged 20-50 years, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized to receive 75 mg diclofenac IM 8 hourly (Group D) or 1 g paracetamol IV 8 hourly (Group P) or a combination of both 8 hourly (Group PD) for 24 h post-operative period from the start of surgery. The primary outcome measured was the requirement of rescue analgesic (tramadol), the secondary outcomes measured included visual analog score (VAS) for pain, time until first rescue analgesic administration, patient satisfaction score and any side effects.
  
  
  RESULTS
  The requirement of rescue analgesic was significantly lower in Groups D and PD compared to Group P. Mean (standard deviation) tramadol requirement during 24 h was 56.67 (62.60) mg, 20.00 (40.68) mg and 20.00 (40.68) mg in the Groups P, D and PD respectively. Less number of patients in Groups D and PD (20% in both the groups) required rescue analgesic compared to Group P (50%). The VAS showed a significant decrease in Groups D and PD compared to Group P between 4 and 12 h post-operatively. However, Group PD showed no significant difference when compared to Group D alone.
  
  
  CONCLUSIONS
  Injection diclofenac IM is more effective than paracetamol IV in terms of rescue analgesic requirement, but the combination of diclofenac IM and paracetamol IV provides no added advantage over diclofenac IM alone.
authors.affiliation: Department of Anaesthesiology, Calcutta National Medical College and Hospital, Kolkatta, West Bengal, India.
authors.forename: Anirban
authors.initials: A
authors.lastname: Pal
authors.affiliation: Department of Obstetrics and Gynecology, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India.
authors.forename: Jhuma
authors.initials: J
authors.lastname: Biswas
authors.affiliation: Department of Anaesthesiology, Calcutta National Medical College and Hospital, Kolkatta, West Bengal, India.
authors.forename: Purnava
authors.initials: P
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Postgraduate Medical Education and Research, Kolkatta, West Bengal, India.
authors.forename: Poushali
authors.initials: P
authors.lastname: Sanyal
authors.affiliation: Department of Obstetrics and Gynecology, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India.
authors.forename: Shyamal
authors.initials: S
authors.lastname: Dasgupta
authors.affiliation: Department of Rheumatology, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India.
authors.forename: Shyamashis
authors.initials: S
authors.lastname: Das
keywords: Lower abdominal gynecological surgery; post-operative analgesia; rescue analgesic