Comparison of Diclofenac Patch and Intramuscular Diclofenac for Postoperative Analgesia in Abdominal Hysterectomy under Spinal Anesthesia: A Prospective, Randomized Clinical Study

Introduction: Immediate postoperative period is very crucial and pain is maximum during first 24 hours. If patients are kept pain free during this period, it leads to vitally stable postoperative period, which in turn leads to early recovery. The aim of this study was to compare the analgesic efficacy of diclofenac sodium via two different routes, intramuscular (IM) and transdermal, in the management of postoperative pain. Materials and methods: After informed written consent, 60 patients of American Society of Anesthesiologists (ASA) grades I to III scheduled for abdominal hysterectomy under subarachnoid blockade were randomized into two groups. Group TP (n= 30) received transdermal diclofenac patch 3 hours before surgery and group IM (n = 30) received IM diclofenac sodium 30 minutes before the end of surgery. Transdermal or IM diclofenac was repeated 12 hours later. Postoperative visual analog scale (VAS) scores, hemodynamic data, requirement of rescue analgesic, patient satisfaction, and adverse reaction if any were recorded every 2 hourly over 24 hours period. If VAS values were >4, 2 mg/kg tramadol was given intravenously as rescue analgesia. Results: Postoperative VAS, hemodynamic data, requirement of rescue analgesia, and patients' satisfaction were comparable in both the groups (p > 0.05). Intramuscular diclofenac has more side effects. Conclusion: Diclofenac transdermal patch provided postoperative pain relief as effectively as IM diclofenac for abdominal hysterectomy, without any significant side effects.