PERIOPERATIVE ADMINISTRATION OF RECTAL DICLOFENAC SODIUM - THE EFFECTON RENAL-FUNCTION IN PATIENTS UNDERGOING MINOR ORTHOPEDIC-SURGERY

In a randomized, double-blind study, we administered placebo and diclo fenac sodium 100 mg suppositories 1 h pre-operatively and on the first post-operative morning to 22 adult patients undergoing minor orthopae dic surgery. A standardized post-operative intravenous fluid regimen w as instituted until oral fluids were tolerated. Renal function was ass essed pre-operatively, and on the first and second post-operative days by the measurement of urine output, creatinine, urea, sodium, potassi um and NAG (N-acetyl-b-D-glucosaminidase) levels and serum creatinine, urea, sodium and potassium concentrations. On the first post-operativ e day, the diclofenac group demonstrated a reduced urinary sodium excr etion. On the second postoperative day, a reduced urinary NAG/creatini ne ratio was observed in the diclofenac group when compared to placebo . We conclude that peri-operative administration of diclofenac causes changes in renal function consistent with prostaglandin inhibition on the first post-operative day but had no lasting adverse effects in thi s group of patients. Our results reinforce the need for caution when a dministering this drug in the context of pre-existing renal impairment .