Correspondence Address:
Jabbari Ali
Department of Anesthesiology and Intensive Care, Babol University Medical Sciences, Babol, Golestan University of Medical Sciences, Golestan
Iran

Full Text

Sir,

Spinal anesthesia is the most consistent block for lower abdomen and orthopedic surgery and shivering is its common complication. Postanesthetic shivering affects about 30-50% of patients. Postoperative pain is another important impediment to recovery from surgery. [1] Therefore, prevention of postoperative pain and postanesthetic shivering should be considered and managed as two important components which demonstrably improve the patients' outcome.

A wide range of drugs, including pethidine, buprenorphine, clonidine, and nonsteroidal anti-inflammatory drugs (NSAIDs) were used to prevent, control, and treat postoperative pain and shivering but they are not without any side effects. Decisions on postoperative analgesia and postspinal anesthesia shivering should be based on the evidence of efficacy and safety. [2],[3]

Pethidine is remarkably effective in shivering and pain treatment and it is known as a standard regimen for postanesthesia shivering suppression and pain management but, owing to the wide range of side effects with pethidine, their replacement with other analgesics has always been considered. [1],[2],[3],[4]

We conducted a multicentral, prospective, double-blind, randomized clinical trial to compare sodium diclofenac and pethidine in prevention of shivering and postoperative pain management and their adverse reactions, after spinal anesthesia. A total of 180 patients were randomly allocated to receive 100 mg sodium diclofenac suppository or 30 mg intravenous meperidine and control group.

There was no respiratory depression, excessive blood loss, and urinary retention in any of our patients but pruritus was repetitive in the pethidine group. Besides, our study showed that incidences of shivering in patients' group of sodium diclofenac suppository were comparable to patients in the pethidine group which was less in contrast to the control group, this finding corroborates with the finding of Piper, et al., who reported that incidence of postoperative shivering was 16.6% with pethidine pretreatment group. [3]

Based on our finding, the analgesic effect of 100 mg rectal diclofenac before the surgery was the same as of 0.5 mg/kg IV pethidine and the patients have shown a similar visual analog scale (VAS) score in 60 minutes after surgery and the results were lower than those in control group. That was comparable with Rashid and his colleagues finding. [4]

A study assessed the efficacy of diclofenac on patients' outcomes after cardiac surgery, where it was concluded that sodium diclofenac has a significant opioid-sparing effect after coronary artery bypass graft. [5] In contrast, Colquhoun and Fell were unable to demonstrate an opioid sparing effect from rectal diclofenac 100 mg administered immediately following major abdominal surgery. [6] Abdollahi, et al. compared pethidine 0.5 mg/kg with 100 mg diclofenac suppository for pain relief after surgery and found no difference of mean pain score between the two groups during the first 8 hours. [7]

We concluded that a single dose of sodium diclofenac suppository can provide satisfactory analgesia immediately following surgery and decrease postspinal shivering and its effect is comparable with pethidine efficacy. We could not find any considerable side effect for suppository diclofenac in our investigation, so suppository diclofenac use is an appropriate replacement therapy for pain relief and shivering control after surgery. This investigation highlights the role of preoperative administration of single dose of rectal diclofenac as a sole analgesic for early postoperative period in spinal anesthesia.

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