title: A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial.
abstract: OBJECTIVE
  Postcraniotomy headache causes considerable pain and can be difficult to treat. We therefore tested the hypothesis that a single 100-mg preoperative dose of diclofenac reduces the intensity of postcraniotomy headache, and reduces analgesic requirements.
  
  
  METHODS
  200 patients having elective craniotomies were randomly assigned to diclofenac (n = 100) or control (n = 100). Pain severity was assessed by an independent observer using a 10-cm-long visual analog scale the evening of surgery, and on the 1st and 5th postoperative days. Analgesics given during the first five postoperative days were converted to intramuscular morphine equivalents. Results were compared using Mann-Whitney-tests; P < 0.05 was considered statistically significant.
  
  
  RESULTS
  Baseline and surgical characteristics were comparable in the diclofenac and control groups. Visual analog pain scores were slightly, but significantly lower with diclofenac at all times (means and 95% confidence intervals): the evening of surgery, 2.47 (1.8-3.1) vs. 4. 37 (5.0-3.7), (P < 0.001); first postoperative day, 3.98 (3.4-4.6) vs. 5.6 (4.9-6.2) cm (P < 0.001) and 5th postoperative day: 2.8 (2.2-3.4) vs. 4.0 ± (3.3-4.7) cm (P = 0.013). Diclofenac reduced systemic analgesic requirements over the initial five postoperative days (mean and 95% CI): 3.3 (2.6-3.9) vs. 4.3 (3.5-5.1) mg morphine equivalents (P < 0.05).
  
  
  CONCLUSIONS
  Preoperative diclofenac administration reduces postcraniotomy headache and postoperative analgesic requirements - a benefit that persisted throughout five postoperative days.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Centre, Hungary. Electronic address: csmolnar@med.unideb.hu.
authors.forename: Csilla
authors.initials: C
authors.lastname: Molnár
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Centre, Hungary.
authors.forename: Éva
authors.initials: É
authors.lastname: Simon
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Centre, Hungary.
authors.forename: Ágota
authors.initials: Á
authors.lastname: Kazup
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Centre, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Gál
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Centre, Hungary.
authors.forename: Levente
authors.initials: L
authors.lastname: Molnár
authors.affiliation: Department of Neurosurgery, University of Debrecen, Health and Medical Science Centre, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Novák
authors.affiliation: Department of Neurology, Semmelweis University, Budapest, Hungary.
authors.forename: Dániel
authors.initials: D
authors.lastname: Bereczki
authors.affiliation: Michael Cudahy Professor and Chair, Department of Outcomes Research, Cleveland Clinic, Cleveland, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Debrecen, Health and Medical Science Centre, Hungary; Outcomes Research Consortium, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Fülesdi
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003399:Craniotomy / Q000009:adverse effects*; D004008:Diclofenac / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology* / Q000517:prevention & control*; D011300:Preoperative Care
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac
keywords: Craniotomy; Postcraniotomy headache; Preventive analgesia