A COMPARISON OF THE EFFECT OF INTRAMUSCULAR DICLOFENAC, KETOROLAC OR PIROXICAM ON POSTOPERATIVE PAIN FOLLOWING LAPAROSCOPY

Sixty patients presenting for in-patient gynaecological laparoscopic s urgery were randomly allocated to receive either diclofenac 75 mg (n=2 0), ketorolac 30 mg (n=20) or piroxicam 20 mg (n=20) as an intra muscu lar (i.m.) injection immediately after induction of anaesthesia. Post- operative Visual Analogue Scores at rest, over the first 24 h after su rgery, using a 10 cm scale, ranged from 3.2-0.5 in the diclofenac grou p, 2.7-0.85 in the ketorolac group and 2.8-0.5 in the piroxicam group. The scores did not differ significantly between the three groups (P>0 .05). Mean time (SD) to first analgesia was 27 (94)min in the piroxica m group, 16 (30) min in the diclofenac group and 62 (120) min in the p iroxicam group. Six out of 20 patients in the diclofenac group require d further analgesia compared with nine out of 20 in the other two drug groups, this was not significant. There were no reports of increased bleeding, bronchoconstriction, bleeding from the upper gastrointestina l tract, renal impairment or pain from the intramuscular (i.m.) inject ion site in any of the groups. The administration of a non-steroidal a nti-inflammatory drug to patients presenting for laparoscopic surgery reduces post-operative pain and analgesic requirements, and piroxicam 20 mg provides a suitable alternative to 75 mg diclofenac and 20 mg ke torolac.