Effect of Diclofenac Suppository on Tramadol Consumption in Posthysterectomy Pain

Objective: To determine reduction in dose of tramadol and side effects in posthysterectomy patients on addition of diclofenac on rectal suppository. Study Design: Randomized double blinded placebo controlled study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, Pakistan, from August 2004 to January 2006. Methodology: Seventy ASA I and II females, aged 20 and above, who underwent elective abdominal hysterectomy, were included in this study. Patients received identical looking suppository of either 100 mg diclofenac sodium or placebo after induction of anaesthesia and then 12 hourly for 24 hours. General anaesthesia was standardized and tramadol was given by patient controlled intravenous analgesia delivery system in the recovery. Results: The mean dose +/- SD of tramadol used in first 24 hours was found to be 317 +/- 153 mg in the placebo-tramadol group compared to 258 +/- 192 mg in the diclofenac-tramadol group (p = 0.15, 95% Cl = 1.24 to -1.34, 6.63). Seventeen (49 %) patients in the placebo-tramadol group and 14 (40%) in the diclofenac-tramadol group used rescue analgesia (p=0.47). Sedation score was similar in both the groups and there was no difference in the incidence of nausea and vomiting and use of antiemetics between the groups. Conclusion: This study did not show any reduction in tramadol consumption, given via patient controlled intravenous analgesia when rectal suppository of 100 mg diclofenac was added.