Preemptive analgesia role of intravenous diclofenac in abdominal hysterectomy under general anesthesia in a limited resource settings: A prospective cohort study

Background: A significant proportion of patients suffer moderate to severe pain after surgery despite wide pain management protocols. Many analgesic drugs have been tried to alleviate perioperative pain. This study aimed at evaluating the effectiveness of diclofenac as a preemptive analgesic for postoperative pain management in patients that underwent abdominal hysterectomy under general anesthesia. Methods A total of 86 ASA I and II participants aged > 18 years old and undergoing abdominal hysterectomy from March to August 2020 in Adama General Hospital were recruited into this prospective observational cohort study. Study participants were grouped as group D (who took preemptive diclofenac) and group ND (who did not) based on whether or not IV diclofenac was given 30 minutes before the surgical incision. The pain severity, total analgesic consumption, first analgesic request time, and incidence of nausea and vomiting within 24 hours postoperatively were compared between the two groups. Student’s t-test and Mann-Whitney U test were used for analyzing numeric data. Categorical variables between the groups were analyzed using the chi-square test. P-values < 0.05 were considered statistically significant. Results Median pain score in the early postoperative period (in the 2nd, 4th, and 8th hr) was significantly lower in the diclofenac group (0.007, 0.004, 0.001, 0.261, and 0.796 respectively). The mean first analgesic request time between the groups was not significantly different (p > 0.05). Total postoperative analgesic consumption was significantly lower in the diclofenac group (p = 0.0006). The occurrence of nausea and vomiting was comparable between the two groups (p > 0.05). Conclusion and Recommendation: Preemptive diclofenac significantly reduced postoperative pain severity and total analgesic consumption and was associated with fewer side effects in patients undergoing gynecologic surgery. We recommend that all anesthesia providers use 75 mg of diclofenac 30 min to 1 hour before surgical incision.