Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate

Abstract

Objectives: The aim of this study was to assess the analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAIDs), administered as intramuscular diclofenac in comparison with intravenous paracetamol after transurethral resection of the prostate (TURP). Materials and Methods: Fifty men, aged 55 to 75 years, undergoing TURP at our hospital were included in this study. Patients were divided randomly and prospectively into two groups (25 patients in each group). Group I (NSAID) received 75 mg of diclofenac i.m. at the end of the operation followed by 75 mg of diclofenac i.m. for 24 hours (75 mg x 2 once a day = 150 mg/24 h) postoperatively. The other group (Group II) consisted of patients who received 1g/100 mL i.v. paracetamol 15 minutes twice daily as postoperative analgesia. Postoperative pain scores were evaluated at 30 minutes, 1, 2, 4 and 6 hours after administration of each analgesic, using a visual analogue scale (VAS). Furthermore, preoperative and postoperative hemoglobin (Hb) levels and hemostatic variables (bleeding time, prothrombine time and the international normalized ratio , i.e. the ratio of a patient's prothrombin time to a normal [control] sample) were recorded in all patients. Results: The pain score changes during a 4 hour period between the two groups was similar (p = 0.162). Thirty minutes after surgery, pain scores were high (> 3 cm) in both groups and without differences between groups (p = 0.11) but 6 hours after surgery, pain scores were significantly higher with paracetamol compared to diclofenac (p < 0.05). No significant difference was observed between the groups regarding the amount of resected tissue, operating time, preoperative-postoperative Hb levels and hemostatic variables. In the both groups, no patient required blood transfusion postoperatively. Conclusions: NSAIDs are not a contraindication to TURP and should be used for the control of postoperative pain if indicated.

Perbedaan Efektivitas Parasetamol Oral Dengan Tramadol Oral Sebagai Tatalaksana Nyeri Pasca Operasi Transurethral Resection of The Prostate

“…(3) Nyeri pasca operasi TURP disebabkan karena trauma (reseksi jaringan prostat), iritasi foley kateter dan traksi kateter pasca TURP pada luka operasi. (4,5,6) Kara C et al Februari 2010 membandingkan efektifitas pemakaian Non Steroid Anti Inflamasi Drugs (NSAID) injeksi diklofenak dengan parasetamol drip. Kara C et all mendapatkan rata-rata nilai VAS pada kedua kelompok adalah > 3 cm pada 30 menit sampai 4 jam pertama pasca TURP Tetapi 6 jam berikutnya Artikel Penelitian terjadi peningkatan yang signifikan pada parasetamol dibandingkan dengan diklofenak.. (6) Pemakaian parasetamol oral dan tramadol oral sebagai analgetik pasca operasi sangat banyak bahkan termasuk salah satu analgetik yang direkomendasikan dalam guidelines manajemen nyeri pasca TURP oleh European Association of Urology.…”

Clinical and Laboratory Hematologic Findings in Patients Receiving Repeated-Dose Injectable HPBCD-Diclofenac for Acute Postoperative Pain: Pooled Analysis of Two Randomized Controlled Phase III Clinical Trials

“…Similarly, a study in patients undergoing transurethral prostate resection reported no added bleeding risk with the use of intramuscular diclofenac versus IV paracetamol [62]. It is important to note, however, that higher postoperative blood loss has been reported with administration of diclofenac versus placebo following breast surgery [63].…”

A Comparative Study of Efficacy and Safety of Lornoxicam and Diclofenac as Postoperative Analgesics After Mastoidectomy Surgery

“…Effective postoperative pain management is an important concern for anesthesiologist and surgeon [10]. Approximately 80% of patients undergoing surgical procedures experience mild to severe post-operative pain, despite the major improvements in the understanding of post-operative pain pathology [9].…”