Use of Topical Diclofenac for Preemptive Analgesia in the Prevention of Post-spinal Back Ache
Objectives: Post spinal back ache has been observed in 29.3% of the patients subjected to spinal anesthesia. Although the pains that may develop in the surgical area are usually primary, secondary to the regional anesthesia intervention, patients have also pain complaints over the intervention area. The preemptive analgesic drugs administered management of the post-operative pain caused by the surgery. Topically used drugs allow the treatment to be administered in smaller doses and more effectively. In our study, we aim to examine the effect of topical medication for preemptive analgesia in the prevention of back ache occurring after the spinal anesthesia intervention.
Methods: For the study, the approval of local ethical committed was obtained. Among the knee arthroscopy patients planned to undergo spinal anesthesia, 106 patients scheduled to have elective surgery. The patients who have prostaglandin inhibitor sensitivity and bleeding problems and are in ASA III-IV group as well as the pregnant women and breastfeeding mothers were excluded from the study. In the 53 patients selected by sealed envelope method, 30 minutes before the surgery, Diclofenac Diethylammonium as in the amount recommended by the manufacturer company was rubbed onto the skin in the lumbal region where the spinal anesthesia to be applied and these patients were named as Diclofenac Group (Group D). To the other 53 patients selected by sealed envelope method, placebo cream was applied in the same way and these patients were named as Placebo Group (Group P). After spinal anesthesia intervention, a 2-2.5 ml dose of Bupivacaine Hydrochloride+Dextrose Monophosphate was administered. When the Bromage motor scale became 3 and heat desensitization was seen, adductor canal catheter was inserted. By using Visual Analog Scale (VAS), the pain in the area of spinal anesthesia intervention were asked and these values were recorded. Starting from the moment that BMS value was found to be 0, VAS values in 1st, 2nd, 4th, 8th, 16th and 24th hours and VAS values 1 week and 6 months after the surgery were recorded. The 1 week-later evaluations were performed in the orthopedics outpatient service and 6 month-later evaluations were carried out through phone call.
Results: In Group D, 1 patient was excluded from the study because no spinal anesthesia was applied and 2 patients were excluded from the study because of the failed implementation of adductor canal block. In Group P, 3 patients were excluded from the study because of the failed implementation of adductor canal block.
No statistical differences were found between the groups’ age ratios, average ages, weights, heights, prior history of spinal anesthesia numbers, spinal anesthesia intervention areas, spinal anesthesia intervention numbers and operation durations. In addition, there was also no statistical difference between the groups in terms of pre-op analgesia, while there is a significant difference between them in terms of the use of post-op analgesia
When the 1st, 2nd, 4th, 8th, 16th, 24th hour VAS values and VAS values 1 week and 6 months after the surgery of the groups were evaluated, there was a significant statistical difference between the two groups.
Discussion: Although there are many enteral and parenteral analgesic and anti-inflammatory systemic drugs, using topical analgesic and anti-inflammatory drugs has been found to be a proper solution for minimizing the systemic side effects.
When we examined the literature, there was only one study about topical NSAİDs . it was found out that throat aches after the laryngeal mask use were less in the group used Benzidamin HCL than the group using placebo
Apart from NSAIDs, there are also other topical locally anesthetic drugs (creams containing lidocaine and prilocaine) and topical trmadole used for preemptive analgesia and they were mainly tested and found successful. Using topical diclofenak in order to prevent back ache commonly seen after spinal anesthesia can reduce the back ache incidence significantly.