The Preemptive Use of Diclofenac Sodium in Combination with Ketamine and Remifentanil Does Not Enhance Postoperative Analgesia After Laparoscopic Gynecological Procedures

Objective: To evaluate the preemptive effects of diclofenac sodium, in combination with remifentanil and ketamine.

Methods: A prospective, randomized, double blind, placebo-controlled trial was carried out at the Hacettepe University Hospital, Ankara, Turkey from September to December 2004. Forty-three, American Society of Anesthesiology physical status group I-II women, aged >18 years, who would undergo both diagnostic and operative laparoscopic surgery were randomly assigned into 2 groups. All patients received intraoperative 0.1 microg x kg(-1)min(-1) remifentanil infusion. Diclofenac (1 mg x kg(-1) intramuscular) was administered, 20 minutes before the operation. Ketamine (0.8 mg x kg(-)1 intravenously) was administered 5 minutes before the skin incision and at completion of skin closure. We divided the patients into 2 groups; Group I (diclofenac + remifentanil + ketamine), Group II (remifentanil + ketamine). Pain was evaluated postoperatively using the visual analogue scale (VAS) while global satisfaction by verbal rating scale (VRS).

Results: All 43 female patients have a mean +/- SD age of 32.3 +/- 6.5 years, height of 163 +/- 5.3 cm, and weight of 62.9 +/- 9.5 kg. The VAS and VRS scores and also time to first analgesic request were not different between the groups. In all groups, >98% of the patients were satisfied or very satisfied.

Conclusion: We have not found any preemptive or additive effect of diclofenac sodium with the concomitant use of ketamine.