Tariq Hayat Khan, Sheikh Arzi Muhammad.
A comparative study of the efficacy of intermittent boluses of Nalbuphine and Diclofenac sodium infusion on post-operative pain.
Anesth Pain Intens Care Jan ;9(2):7-10.

OBJECTIVE: This prospective randomized single blind trial was designed to compare and evaluate the efficacy of intravenous diclofenac sodium with narcotic analgesics, for post operative pain management, and establish the safety of use of intravenous diclofenac sodium. SETTINGS: Department of Anaesthesiology, Pain & Intensive Cares, Combined Military Hospital, Hyderabad. STUDY PERIOD: April 2001 to April 2002. PATIENT & METHODS: Hundred patients undergoing different types of surgeries were studied. All the patients were followed for 48 hours post operatively. The patients were American Society for Anaesthesiologist Physical Status of I and II, and aged more than 15 years. A standardized anaesthetic technique consisting of thiopentone- suxamethonium for induction; and oxygen, nitrous oxide, halothane, with or without pancuronium for maintenance of anaesthesia was used. First group of 50 patients received inj. Nalbuphine 5mg IV, which was continued in doses of 2-3 mg intermittently, post-operatively. The second groups of 50 patients were administered 75 mg of diclofenac intramuscularly just after induction. This group also received a continuous infusion of diclofenac at a rate of 75 mg per 6 hours postoperatively. The duration of 75 mg infusion was increased after 12 hours, according to the response of the patient. In spite of the continuous infusion, if pain persistently remained above 5 on VAS, rescue analgesia was provided with 2-3 mg nalbuphine IV to these patients. 98% of patients remained almost pain free on IV infusion of diclofenac sodium and rescue analgesia was never required in them. The effect of intravenous water based diclofenac sodium on vital signs, laboratory values regarding coagulation, hepatotoxicity. nephrotoxicity and clinical side effects were monitored throughout the study period. No significant adverse effects were noted, whereas the incidence of nausea/vomiting and urinary retention was higher with nalbuphine. RESULTS: Intravenous diclofenac was found effective in controlling postoperative pain if given via continued infusion after a bolus dose. Its analgesic efficacy to control post-op pain was comparable to nalbuphine, but the incidence of adverse effects was low key words: diclofenac sodium, nalbuphine.

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