Continuous intravenous diclofenac does not induce opioid-sparing or improve
analgesia in geriatric patients undergoing major orthopedic surgery.
Author(s): Fredman B, Zohar E, Tarabykin A, Shapiro A, Jedeikin R.
Affiliation(s): Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar, Saba,
Israel.
Publication date & source: 2000, J Clin Anesth. , 12(7):531-6
STUDY OBJECTIVE: To assess the analgesic efficacy and perioperative
opioid-sparing effects of adjuvant intravenous (IV) diclofenac.
DESIGN: Prospective, controlled, double-blind study.
SETTING: Large referral hospital.
PATIENTS: 40 ASA physical status I, II, and III geriatric patients (>65 years)
undergoing open reduction and internal fixation of subcapital fracture of the
femur.
INTERVENTIONS: A standardized general anesthetic was administered. On induction
of anesthesia, patients in the diclofenac group received an IV bolus of
diclofenac (0.7 mg/kg) followed by a constant infusion (0.15 mg/kg/hr) until the
end of surgery. In the saline group, an equal volume of saline was administered.
"Rescue" fentanyl was administered in response to an increase in mean arterial
pressure or heart rate (exceeding 20% of the patient's preinduction "baseline"
values) that did not respond to a 30% increase in the inspired isoflurane
concentration. Postoperative pain was assessed using a four-point
patient-generated pain score (1 = none, 2 = mild, 3 = moderate, 4 = severe) as
well as number of attempts and actual morphine delivered via a patient-controlled
analgesia (PCA) device.
MEASUREMENTS AND MAIN RESULTS: The two treatment groups were demographically
comparable. The perioperative hemodynamic variables, as well as the induction and
"rescue" fentanyl dosages, were unaffected by the treatment modality. Pain
scores, PCA attempts, and actual morphine delivered were statistically similar
between the two groups.
CONCLUSIONS: Adjuvant IV diclofenac does not improve intraoperative stability or
decrease postoperative opioid requirements in geriatric patients undergoing
internal fixation of subcapital fracture of the femur.
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