Preoperative or postoperative diclofenac for laparoscopic tuballigation

We have compared the analgesic effects of diclofenac given before operation or immediately after operation in a randomized, double-blind, double-dummy study of 40 healthy female patients under going laparoscopic tuballigation. Group 1 patients received diclofenac 75 mg as a 3-ml i.m. injection 1–2 h before operation and normal saline 3 ml i.m. immediately after surgery. Group 2 patients received normal saline 3 ml i.m. before operation and diclofenac 75 mg i.m. immediately after surgery. Outcome measures were patients' perception of pain on a visual analogue scale (VAS), verbal response scale (VRS), the number of patients who required postoperative morphine, time to first post-operative morphine injection and total dose of morphine given. VAS at 30 mm and at 1, 3 and 6 h after operation were, respectively (median, interquartile range) 4.5 (2.3–6.0) vs 5.3 (2.8–7.8); 3.3 (2.3–5.0) vs 4.4 (3.0–5.8); 1.4 (0–2.3) vs 1.9 (0.8–3.0); 0.5 (0–1) vs 0.7 (0–1.3), (ns). VRS at 1 and 3 h after operation were, respectively, (median, interquartile range) 2.2 (1.5–3.0) vs 2.7 (2.0–4.0) and 0.8 (0–1.3) vs 0.9 (0–1.5) (ns). Sixteen patients in group 1 compared with 17 in group 2 required postoperative morphine. Time to first morphine administration and dose given were, respectively, (median, interquartile range) 50.6 (39–60) min vs 35.7 (20–49) min ( P = 0.1) and 9.0 (5–10) mg vs 9.5 (7.5–10) ( P – 0.9). We conclude that in patients presenting for laparoscopic tubal ligation, preoperative administration of diclofenac 75 mg i.m. conferred no additional analgesic benefit compared with a similar dose given after operation.