Comparison of sodium diclofenac, ketamine and propofol with fentanyl and midazolam in balanced anaesthesia

Abstract

Context:Analgesia is based on balanced anaesthesia, which is usually maintained by administration of narcotic agents. In some patients, it is not possible to use narcotics. We compared hemodynamic changes, anaesthesia depth, emetic sequelae and post-operative pain between sodium Diclofenac, Ketamine-Propofol (DKP) and Fentanyl-Midazolam (FM).Aims:The effectiveness of an anaesthetic technique employing sodium was compared against in patients undergoing elective surgery.Settings and Design:In a clinical trial study, 82 patients who attended for an elective surgery were randomly divided into two groups.Materials and Methods:In DKP group pre-medication included Sodium Diclofenac 1 mg/kg and Midazolam 0.02 mg/kg, whereas, in FM group they were Fentanyl 2 μg/kg and Midazolam 0.02 mg/ kg. Anaesthesia induction in both groups was the same. Anaesthesia was conserved in DKP group by using Propofol plus Ketamine infusion plus N2O 50% and in FM group with Fentanyl plus Midazolam plus N2O 50%. Hemodynamic changes, depth of anaesthesia, nausea and vomiting, post operative analgesic effects were recorded.Results:Hemodynamic changes and depth of anaesthesia were similar throughout the maintenance phase in two groups. In FM group, significant increase in heart rate was recorded in recovery room. Pain score according to visual analogue scale (VAS) and need for analgesics, was significantly more in FM group compared to DKP group (P = 0.000). No patient suffered from nausea, vomiting or hallucinations.Conclusions:This study revealed that intravenous administration of Sodium Diclofenac along with Ketamine and Propofolplus N2O 50% for general anaesthesia provides a balanced anaesthesia as well as hemodynamic stability, and adequate depth of anaesthesia. It also reduces the postoperative pain and need for narcotics. We recommended DKP plus N2O 50% method for patients prohibited from opioid administration. It will be an acceptable method in sensitive patients.

Evaluating the efficacy and safety of simple combination of analgesics with and without low dose opioid for perioperative analgesia, hemodynamic and recovery profile in various surgeries posted under general anaesthesia: a prospective randomised controlled study

“…7 As a part of balanced anaesthesia regimen opioids have been used to alleviate perioperative pain with the advent of availability of various non-opioid analgesics with different mechanisms of action and also raising concerns regarding the adverse effects of opioids, the usage of analgesics like Lignocaine etc, Paracetamol, Diclofenac, Ketamine, Dexmedetomidine etc have been used in the recent years. 8 Various studies have been published highlighting the importance of opioid-free analgesia in general anaesthesia owing to improved postoperative complication rate when compared to opioid based general anaesthesia regimens. 9 In the present study simple combination of analgesics versus simple combination of analgesics with low dose opioid compared in surgeries posted under general anaesthesia.…”

Comparative study of GA and MAC Anesthesia Methods Effects on Oocyte Retrieval in Patients Under IVF Programs

“…Opioids like fentanyl and remifentanil have not appeared to affect reproductive success (16). Furthermore, the application of midazolam and ketamine during assisted reproduction is reported as safe drugs (17). Recently, new findings are supporting the use of propofol as a safe alternative assisted reproduction (18).…”

Analysis of clinical efficacy and safety of intravenous use of diclofenac for the prevention of postoperative pain: current status and strategic aspect

“…A randomized, double-ended study, dentistry (n=50) [21] Preoperative intravenous diclofenac 75 mg is more effective than tramadol 50 mg in the prevention of postoperative dental pain 13 Randomized, surgery (n=82) [22] It has established decreased postoperative pain and need for drugs with intravenous diclofenac 14 Randomized, placebo-controlled, dentistry (n=169) [23] Single doses of intravenous diclofenac provide significant pain relief after surgery on the third molar 15 A prospective, randomized, doubleblind, placebo-controlled trial caesarean section (n=90) [24] Intravenous administration of diclofenac reduced the need for morphine…”