Preoperative diclofenac is a useful adjunct to spinal anesthesia for day-case varicose vein repair.

PURPOSE To examine if preoperative diclofenac 50 mg or diazepam 10 mg po are useful adjuncts to spinal anesthesia for day-case varicose vein repair. METHODS Two hundred ASA physical status I-II outpatients, age 18-60 yr, were randomized to receive either diclofenac 50 mg po or diazepam 10 mg po one hour before operation in a double-blind fashion (100 patients in both groups). If the patient was distressed or feared the spinal puncture and requested sedation, a bolus dose of alfentanil 0.5 mg was given i.v. as a rescue medication. On request, patients received diclofenac 50 mg po and, when needed, oxycodone 0.1 mg x kg(-1) im for postoperative pain relief. They were discharged with a supply of diclofenac 50 mg tablets and were asked to record postoperative pain using a visual analogue scale (VAS) and quantity of tablets taken. RESULTS The VAS scores (+/- SD) eight hours after surgery, the next morning, and in the morning and at the end of the first and second postoperative days were 23 +/- 21, 12 +/- 17, 11 +/- 15, 8 +/- 15 and 8 +/- 15 in the diclofenac group, and 24 +/- 23, 12 +/- 20, 10 +/- 17, 8 +/- 16 and 7 +/- 14 in the diazepam group, respectively (NS). In the diclofenac and diazepam groups, 31% and 67% of the patients required postoperative diclofenac during the first eight postoperative hours (P <0.05). Diazepam premedication did not alter the number of patients who required alfentanil before spinal puncture. CONCLUSION Diclofenac premedication reduced the analgesic requirements during the first eight hours after varicose vein repair.