Preoperative diclofenac is a useful adjunct to spinal anesthesia for day-case varicose vein repair

Purpose: To examine if preoperative diclofenac 50 mg or diazepam 10 mg po a re useful adjuncts to spinal anesthesia for daycase varicose vein repair. Methods: Two hundred ASA physical status I-II outpatients, age 18-60 yr, we re randomized to receive either diclofenac 50 mg po or diazepam 10 mg po on e hour before operation in a double-blind fashion (100 patients in both gro ups). If the patient was distressed or feared the spinal puncture and reque sted sedation, a bolus dose of alfentanil 0.5 mg was given iv as a rescue m edication, On request, patients received diclofenac 50 mg po and, when need ed, oxycodone 0.1 mg(.)kg(-1) inn for postoperative pain relief. They were discharged with a supply of diclofenac 50 mg tablets and were asked to reco rd postoperative pain using a visual analogue scale (VAS) and quantity of t ablets taken. Results: The VAS scores (+/- SID) eight hours after surgery, the next morni ng, and in the morning and at the end of the first and second postoperative days were 23 +/- 21, 12 +/- 17, 1 1 +/- 15, 8 +/- 15 and 8 +/- 15 in the d iclofenac group, and 24 +/- 23, 12 +/- 20, 10 +/- 17, 8 +/- 16 and 7 +/- 14 in the diazepam group, respectively (NS). In the diclofenac and diazepam g roups, 31% and 67% of the patients required postoperative didofenac during the first eight postoperative hours (P < 0.05). Diazepam premedication did not alter the number of patients who required alfentanil before spinal punc ture. Conclusion: Diclofenac premedication reduced the analgesic requirements dur ing the first eight hours after varicose vein repair.