Prospective comparative study of use of diclofenac suppository (150 mg) and intramuscular diclofenac (75 mg) for pain management of patients in post-operative laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is a gold standard surgical procedure for treatment of gallstone disease. Early postoperative pain management will lead to early ambulation, early recovery. This study will help us to make a conclusion whether to use rectal suppositories of NSAIDS as effective alternative to intramuscular injection of NSAIDS for postoperative pain management and recovery of the patients in laparoscopic cholecystectomy. Rationale of this study is to check the effectiveness of Diclofenac rectal suppositories on postoperative patients for pain and morbidity. Methods: Study was conducted in 50 patients. Diclofenac 150mg suppository (one and half) introduced per rectally at the time of induction of anaesthesia in 25 patients and in another group, 75 mg diclofenac injection given intramuscularly at the time of induction of anaesthesia in another 25 patients. Only single dose of diclofenac administered. For any pain complaints (VAS >3), a dose of intravenous paracetamol 1 gram was given SOS with minimum interval of 6 hours in both group. Readings was taken at an interval of 6, 12 and 24 hours postoperatively. Results: There is significant reduction in postoperative pain in group A compare to group B according to VAS with significant p value (0.005 in 6 hours, <0.001 in 12 hours and <0.001 in 24 hours postoperatively). % of decrease in VAS is more in group A with p value 0.001 in 12 hours and 0.004 in 24 hours postoperatively. Conclusions: In conclusion per rectal suppository of diclofenac for Laparoscopic cholecystectomy reduces pain in the initial postoperative period, it is easy to administer with no adverse effects and may become routine practice for this procedure. This simple, safe, inexpensive, effective form of diclofenac thus improve postoperative analgesia in hospital course. We advocate its use in all elective laparoscopic cholecystectomies.