The preemptive use of diclofenac sodium in combination with ketamine and remifentanil does not enhance postoperative analgesia after laparoscopic gynecological procedures

To evaluate the preemptive effects of diclofenac sodium, in combination with remifentanil and ketamine. A prospective, randomized, double blind, placebo-controlled trial was carried out at the Hacettepe University Hospital, Ankara, Turkey from September to December 2004. Forty-three, American Society of Anesthesiology physical status group I-II women, aged >18 years, who would undergo both diagnostic and operative laparoscopic surgery were randomly assigned into 2 groups. All patients received intraoperative 0.1 microg x kg(-1)min(-1) remifentanil infusion. Diclofenac (1 mg x kg(-1) intramuscular) was administered, 20 minutes before the operation. Ketamine (0.8 mg x kg(-)1 intravenously) was administered 5 minutes before the skin incision and at completion of skin closure. We divided the patients into 2 groups; Group I (diclofenac + remifentanil + ketamine), Group II (remifentanil + ketamine). Pain was evaluated postoperatively using the visual analogue scale (VAS) while global satisfaction by verbal rating scale (VRS). All 43 female patients have a mean +/- SD age of 32.3 +/- 6.5 years, height of 163 +/- 5.3 cm, and weight of 62.9 +/- 9.5 kg. The VAS and VRS scores and also time to first analgesic request were not different between the groups. In all groups, >98% of the patients were satisfied or very satisfied. We have not found any preemptive or additive effect of diclofenac sodium with the concomitant use of ketamine.