A randomized clinical study to compare pre-emptive analgesic efficacy of clonidine and diclofenac sodium in patients undergoing major surgeries at a tertiary care hospital

Prachi Jain; Uma Bhosale; Shashank Desai

doi:10.18203/2319-2003.ijbcp20205536

Authors

Prachi Jain Department of Pharmacology, H. B. T. Medical College and R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India
Uma Bhosale Department of Pharmacology, Smt. Kashibai Navale Medical College and General Hospital, Mumbai, Maharashtra, India
Shashank Desai Department of Pharmacology, H. B. T. Medical College and R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20205536

Keywords:

Pre-emptive analgesia, Clonidine, Diclofenac, VAS, Aldrete’s scale

Abstract

Background: Pre-emptive analgesia is a method to achieve analgesia even before exposure to a noxious stimulus The purpose of pre-emptive analgesia is to reduce pain caused due to surgical incision triggered inflammatory mechanism activation; and to ensure a good post-operative pain control so that there is no development of chronic pain. Clonidine is an α2 adrenergic agonist thus it decreases the sympathetic outflow, while Diclofenac is a non-steroidal anti-inflammatory agent. Our literature review showed that both clonidine (150 μg) and diclofenac are efficacious pre-emptive analgesics. Literature review also revealed that there is no study available to compare pre-emptive analgesic efficacy as well as safety of oral clonidine with diclofenac, therefore present study was designed to compare pre emptive analgesic efficacy of these two drugs.

Methods: This randomized clinical study included 100 patients from surgical departments, of either sex, between 18 to 70 years age and of American society of anesthesiologists (ASA) I/II grade. Patients were randomly allocated to two groups and received either of the treatments 30 minutes prior to induction of anesthesia. Pain scores were recorded using visual analog scale, facial rating scale and behavioral rating scale at awakening and at 1, 2, 4, 6 and 24 hours. Postoperative analgesic requirement over 24 hours was recorded. Data were analyzed using OpenEpi statistical softwares.

Results: Significantly lower pain scores were observed in clonidine group as compared to Diclofenac at 4 and 6 hours (p<0.05) on all the pain scales. Clonidine group also required less postoperative analgesic as compared to diclofenac (p<0.05).

Conclusions: Study results are strongly suggestive of greater pre-emptive analgesic efficacy of clonidine over diclofenac in major surgeries done under spinal anesthesia.

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References

Lovich-Sapola J, Smith CE, Brandt CP. Postoperative Pain Control. Surg Clin North Am. 2015;95(2):301-18.

Vasure R, Ashahiya ID, Mahendra R, Narang N, Bansal RK. Comparison of Effect of Adding Intrathecal Magnesium Sulfate to Bupivacaine Alone and Bupivacaine-Fentanyl Combination during Lower Limb Orthopedic Surgery. Int J Sci Study. 2016;3(10):141-6.

Kolarkar P, Badwaik G, Watve A, Agarkar S, Kalbande J, Giri A, et al. Pre-emptive oral clonidine for immediate postoperative pain in surgeries under sub-arachnoid block. J Evol Med Dent Sci. 2014;3:11913-21.

Kashefi P, Honarmand A, Safavi M. Effects of preemptive analgesia with celecoxib oral acetaminophen on postoperative pain relief following lower extremity orthopedic surgery. Adv Biomed Res. 2012;1:66.

Woolf CJ, Chong MS. Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77(2):362-79.

Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50(2):222-7.

Beniwal S, Chaudhary S. Pre-emptive oral pregabalin versus clonidine for immediate post-operative pain in surgeries under sub arachnoid block. Available at: www.wjpmr.com. Accessed on 20 July 2020.

Shah P, Bhosale UA, Gupta A, Yegnanarayan R, Sardesai S. A randomized double-blind placebo-controlled study to compare preemptive analgesic efficacy of novel antiepileptic agent lamotrigine in patients undergoing major surgeries. North Am J Med Sci. 2016;8(2):93.

Gupta K, Singh I, Singh VP, Gupta P, Tiwari V. Preemptive analgesia of oral clonidine during subarachnoid block for laparoscopic gynecological procedures: A prospective study. Anesth Essays Res. 2014;8(2):187.

Zacharias M, Hunter K, Baker B. Effectiveness of preoperative analgesics on postoperative dental pain: A study. Anesth Prog. 1996;43:92-6.

Singh S, Arora K. Effect of oral clonidine premedication on perioperative haemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Indian J Anaesth. 2011;55(1):26-30.

Hayashi Y, Maze M. Alpha 2 adrenoceptor agonists and anaesthesia. Br J Anaesth. 1993;71(1):108-18.

Sung CS, Lin SH, Chan KH, Chang WK, Chow LH, Lee TY. Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Sin. 2000;38(1):23-9.

Ong CK-S, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100(3):757-73.

Hiller A, Silvanto M, Savolainen S, Tarkkila P. Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy. Acta Anaesthesiol Scand. 2004;48(9):1185-9.

Romsing J, Ostergaard D, Drozdziewicz D, Schultz P, Ravn G. Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients. Acta Anaesthesiol Scand. 2000;44(3):291-5.

Schmidt A, Bjorkman S, Akeson J. Preoperative rectal diclofenac versus paracetamol for tonsillectomy: effects on pain and blood loss. Acta Anaesthesiol Scand. 2001;45(1):48-52.

White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101(5):5-22.

Schafer AI. Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis. J Clin Pharmacol. 1995;35(3):209-19.

Bjorkman D. Nonsteroidal anti-inflammatory drug-associated toxicity of the liver, lower gastrointestinal tract, and esophagus. Am J Med. 1998;105(5A):17-21.