Total intravenous anaesthesia for day-care surgery using diclofenac for analgesia - abstract

The trend in modern surgery is to do more and more cases as "Day Care". This approach saves money by promoting the efficient use of available bed space and the time of hospital-based health professionals. The main objective of the anaesthetic technique is to produce conditions satisfactory to surgeon and patient, using agents that allow for the safe and rapid discharge of the patient from the hospital. Inhalation techniques with halothane and by using narcotics for post-operative analgesia are the standard techniques used in the Queen Elizabeth Hospital in Barbados. However, studies have shown that the combination of various narcotics such as Fentanyl and Alfentanyl for analgesia in total intravenous anaesthesia techniques, using continuous intravenous Propofol, will produce satisfactory anaesthesia for many types of surgical procedures with short recovery periods. Substitution of analgesics in the non-steroidal anti-flammatory drug group (NSAIDs), in combination with Propofol, offers the opportunity for avoiding the side-effects of narcotics. Accordingly, the effectiveness of total intravenous anaesthesia, using Propofol with the NSAID Diclofenac for analgesia in patients undergoing laparoscopic gynaecological surgery as day-care patients was compared with the standard inhalation anaesthetic technique, using a narcotic (Fetanyl) analgesia. The thirty-eight female patients studied were induced with Propofol (2.5 mg/kg-1) for muscle relaxation. Nineteen received Fentanyl (1-1.5 µgm kg-1) i.v. immediately prior to induction and anaesthesia was continued, using 50 percent nitrous oxide (2-1 min-1) in oxygen and Halothane (1-1.5 percent). The other nineteen received Diclofenac (75 mg i.m.) one hour before surgery and anaesthesia was continued with an infusion of Propofol, using an Ohmeda 9000 syringe pump at 12 mg. kg-1.h-1. Conditions for surgery were satisfactory in both groups and there was no signidicant difference in the degree of post-operative analgesia or the time to awaken under anaesthesia and all patients said they would be happy to have the anaesthetic technique used again. However, the total intravenous technique is expensive and therefore its use is recommended only when inhalation methods or the use of narcotics in undesirable (AU)