Evaluation of a diclofenac transdermal patch for the attenuation of venous cannulation pain: a prospective, randomised, double‐blind, placebo‐controlled study

Abstract

SummaryVenous cannulation, although a minor procedure, is often painful. The present study was planned to evaluate the efficacy of a diclofenac transdermal patch placed over the venepuncture site in decreasing the pain of cannulation. Seventy-two adults undergoing elective surgery were included in this randomised, prospective, double-blind, placebo-controlled study. Patients were divided into three equal groups. The Control group had a placebo adhesive patch placed on the both the dorsum of hand and the buttock; the Diclofenac-Buttock group had a placebo patch placed on the dorsum of the hand and a diclofenac transdermal patch on the buttock; the Diclofenac-Hand group had a diclofenac transdermal patch placed on the dorsum of hand and a placebo patch on the buttock. The patches were applied 1 h before cannulation. An 18G cannula was used for all venous cannulations. Pain during cannulation was assessed on a non-graduated 10-cm visual analogue scale. Median Analgesia is an integral part of anaesthesia management. Venous cannulation is painful but is often performed without any analgesia. Cannulation pain has been ranked fifth out of 33 low-morbidity adverse clinical outcomes listed by expert anaesthetists when both clinical importance and frequency were considered [1]. Various methods like application of local anaesthetic cream, ethyl chloride spray, distraction tactics, the 'cough trick' and the Valsalva manoeuvre during venous cannulation have been tried in the attempt to minimise pain, but with unreliable results [2][3][4][5][6].The topical application of non-steroidal anti-inflammatory drugs (NSAIDs) has been reported to be effective in decreasing both acute and chronic pain [7]. Application of NSAID gel to the venous cannulation site has been reported to decrease the incidence of thrombophlebitis [8] but a literature search did not reveal any study evaluating the efficacy of the application of a NSAID patch on venous cannulation pain. The present study was therefore planned to evaluate the efficacy of a diclofenac transdermal patch placed at the venepuncture site for attenuating cannulation pain. MethodsAfter Local Research Ethics Committee approval and written, informed consent, 72 adult patients aged 16-60 years, ASA physical status I or II, of either sex, and scheduled for elective minor surgical procedures lasting < 1 h, were included in this prospective, randomised, double-blind, placebo-controlled study. The study was conducted during the period 1 January)26 July 2005. Presuming that therapy would decrease venepuncture pain by 30%, a power calculation with a = 0.05 and b = 0.8 suggested that we would need to enrol 24 patients into each group. Subjects taking NSAIDs regularly, those with an allergy or sensitivity to NSAIDs, communication problems, and abnormal skin conditions such as infection

Efficacy of power strips as an alternate pain relief method in dental extractions: a clinical trial

“…Reports of another study revealed that while using transdermal diclofenac patch for the attenuation of venous cannulation, there was an occurrence of localized erythematous rash or pruritis at the site of application of the transdermal patch. 18 This finding is in contrast to the present study reports.…”

Comparison of transdermal diclofenac patch with oral diclofenac as an analgesic modality following multiple premolar extractions in orthodontic patients: A cross over efficacy trial

“…Agarwal et al ,[16] when using the transdermal diclofenac patch for the attenuation of venous cannulation, reported the occurrence of a localized erythematous rash or pruritis at the site of application of the transdermal patch. This finding is contrary to those in the present study perhaps due to the fact that each successive application of the diclofenac patch was done at a different site.…”

Efficacy and safety of transdermal diclofenac patch versus intramuscular diclofenac injections in postoperative patients of inguinal hernia

“…Topical application of NSAIDs has been reported to be effective in decreasing both acute and chronic pain. 25 Transdermal patch which is a new innovation in the drug delivery system offers many advantages such as painless administration of drug, increased bioavailability, maintenance of constant and prolonged drug level, reduced frequency of dosing, minimization of inter and intra patient variability, easy self-administration and easy termination of medication, leading to better patient compliance. [12][13][14] It also offers a good option for those patients who are unable to administer drug orally.…”