Key result
Pretreatment with diclofenac before elective unilateral total hip arthroplasty significantly increased total perioperative blood loss by 34.8% (1096 vs 812 ml) in general anesthesia and 32.9% (1042 vs 784 ml) in regional anesthesia.
Why the study?
Does pretreatment with diclofenac increase perioperative blood loss in patients undergoing elective total hip arthroplasty?
RCT (n=120)
Randomized to four equal groups
No
Does pretreatment with diclofenac increase perioperative blood loss in patients undergoing elective total hip arthroplasty?
Mean Difference: 284
Absolute Event Rate: 1096% vs 812%
p-value: p=<0.05
Preoperative administration of diclofenac significantly increases perioperative blood loss in patients undergoing elective total hip arthroplasty, suggesting that non-selective NSAIDs should be discontinued prior to major orthopedic surgery.
Diclofenac pretreatment should be avoided before elective hip arthroplasty; confirms heightened perioperative bleeding risk with preoperative NSAIDs.
Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg) and also as intramuscular injection (75 mg) preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05) compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac) before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.
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Gvozdenović et al. (2011) conducted an RCT in Elective unilateral total hip arthroplasty for coxarthrosis (n=120). Diclofenac vs. No NSAID pretreatment (Control/Placebo) was evaluated on Total blood loss (during surgery and first 24 hours) in general anesthesia (MD 284 ml (34.8% increase), p=<0.05). Pretreatment with diclofenac before elective unilateral total hip arthroplasty significantly increased total perioperative blood loss by 34.8% (1096 vs 812 ml) in general anesthesia and 32.9% (1042 vs 784 ml) in regional anesthesia.
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