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Diclofenac improves lidocaine’s analgesic efficacy during benign anorectal surgery

07 Dec 2018

The combination of lidocaine and diclofenac is superior to lidocaine alone at reducing pain during benign anorectal surgery (BARS), a recent study has shown.

Researchers randomly assigned 120 patients undergoing BARS to receive topical treatment of either lidocaine plus diclofenac (n=60; mean age 47.37±11.79 years; 50 percent male) or lidocaine alone (n=60; mean age 47.73±11.79 years; 70 percent male). Treatment was applied every 12 hours for the first 3 postoperative days and once-daily from the fourth to sixth day. Reasons for receiving BARS included haemorrhoids, anal fissures and anal fistulae.

Pain intensity, as measured by the visual analogue scale (VAS), was significantly lower in the first 3 postoperative days in patients who received the combination treatment (7.47±13.09 vs 4.38±6.75; difference, –3.21; 95 percent CI, –5.75 to –0.68; p=0.008). The same was true when analysis was extended to the first 6 days after operation (8.08±14.50 vs 4.26±6.55; difference, –3.92; –6.62 to –1.22; p=0.004).

Moreover, significantly more patients who received both treatments reported pain reduction 9 mm relative to those who received the monotherapy (35 percent vs 18.33 percent; relative risk [RR], 1.91; 1.01–3.60; p=0.03).

Researchers found similar trends for the probability of progressing from high to lower pain levels, according to VAS cutoffs, though values were only of borderline significance (RR, 1.43; 0.98–2.09; p=0.06).

Both treatments were comparatively safe, with no reported cases of associated adverse events for the first 7 postoperative days.

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