title: Comparison of sodium diclofenac, ketamine and propofol with fentanyl and midazolam in balanced anaesthesia.
abstract: BACKGROUND
  Analgesia is based on balanced anaesthesia, which is usually maintained by administration of narcotic agents. In some patients, it is not possible to use narcotics. We compared hemodynamic changes, anaesthesia depth, emetic sequelae and post-operative pain between sodium Diclofenac, Ketamine-Propofol (DKP) and Fentanyl-Midazolam (FM).
  
  
  OBJECTIVE
  The effectiveness of an anaesthetic technique employing sodium was compared against in patients undergoing elective surgery.
  
  
  METHODS
  In a clinical trial study, 82 patients who attended for an elective surgery were randomly divided into two groups.
  
  
  METHODS
  In DKP group pre-medication included Sodium Diclofenac 1 mg/kg and Midazolam 0.02 mg/kg, whereas, in FM group they were Fentanyl 2 μg/kg and Midazolam 0.02 mg/ kg. Anaesthesia induction in both groups was the same. Anaesthesia was conserved in DKP group by using Propofol plus Ketamine infusion plus N2O 50% and in FM group with Fentanyl plus Midazolam plus N2O 50%. Hemodynamic changes, depth of anaesthesia, nausea and vomiting, post operative analgesic effects were recorded.
  
  
  RESULTS
  Hemodynamic changes and depth of anaesthesia were similar throughout the maintenance phase in two groups. In FM group, significant increase in heart rate was recorded in recovery room. Pain score according to visual analogue scale (VAS) and need for analgesics, was significantly more in FM group compared to DKP group (P = 0.000). No patient suffered from nausea, vomiting or hallucinations.
  
  
  CONCLUSIONS
  This study revealed that intravenous administration of Sodium Diclofenac along with Ketamine and Propofolplus N2O 50% for general anaesthesia provides a balanced anaesthesia as well as hemodynamic stability, and adequate depth of anaesthesia. It also reduces the postoperative pain and need for narcotics. We recommended DKP plus N2O 50% method for patients prohibited from opioid administration. It will be an acceptable method in sensitive patients.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Mozaffar
authors.initials: M
authors.lastname: Rabiee
authors.affiliation: Department of Anaesthesiology and Intensive Care, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Alijanpour
authors.affiliation: Researcher of Deputy of Treatment, Golestan University of Medical Sciences, Golestan, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Jabbari
authors.affiliation: Department of Psychiatry, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Farzan
authors.initials: F
authors.lastname: Khirkhah
authors.affiliation: Department of Anaesthesiology and Intensive Care, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Yousof
authors.initials: Y
authors.lastname: Mortazavi
authors.affiliation: Non Communicable Paediatric Research Center, Babol University of Medical Sciences, Babol, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Bijani
keywords: Balanced anaesthesia; ketamine; propofol; sodium diclofenac