Analgesia for day surgery. Evaluation of the effect of diclofenac given before or after surgery with or without bupivacaine infiltration.

One hundred patients undergoing breast lump excision using a standard anaesthetic technique in the Day Care Unit were randomly divided into five groups. Groups A and B received either saline or diclofenac in a double-blind fashion before and at the end of the procedure, with both groups receiving 10 ml of 0.5% bupivacaine infiltration at the end. Groups C and D also received saline or diclofenac before and after surgery but had no bupivacaine infiltration at the end. Group E did not receive any injections but had bupivacaine infiltration at the end of surgery. In the postoperative period, pain was assessed by a visual analogue scale at 30 min intervals until discharge. All patients were requested to complete a pain relief questionnaire over the 48 h following surgery. There were highly significant differences between those who received bupivacaine and those who did not in the visual analogue scale scores at 30 min (p < 0.001), 60 min (p < 0.001), 120 min postoperatively (p = 0.02) and at discharge (p = 0.03). Pain scores were lower in those who received bupivacaine and they were less likely to request rescue medication, although this did not reach significance (p = 0.07). There were significant differences between the groups who received bupivacaine and diclofenac injection and those who received bupivacaine alone for visual analogue scale scores at 60 min following surgery (p = 0.05) and at 48 h (p = 0.002). Pain relief was better in those patients who received both bupivacaine and diclofenac injection. Although not significant (p = 0.22), fewer patients required rescue medication when diclofenac was given before surgery (10%) rather than after surgery (22.5%). Fewer patients had a fair amount or a great deal of pain in the 48 h following surgery when diclofenac was injected before (7.5%) rather than after surgery (12.5%). The mean number of oral analgesics taken in the 48 h after surgery was also lower in those patients who had the diclofenac before the surgery rather than after.