Comparison of Pre-Emptive Intravenous Diclofenac Versus Intravenous Paracetamol for Postoperative Analgesia in Patients Undergoing Laparoscopic Surgeries Under General Anaesthesia

Background: Effective postoperative analgesia is an essential component of perioperative care, as inadequate pain control may lead to delayed recovery, prolonged hospital stay, impaired respiratory function, increased stress response, and reduced patient satisfaction. Although opioids remain commonly used for postoperative pain management, their adverse effects such as sedation, nausea, vomiting, respiratory depression, and delayed mobilization have encouraged the use of opioid-sparing multimodal analgesic techniques. Non-opioid analgesics such as diclofenac and paracetamol are widely used for perioperative pain management. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), provides analgesia through inhibition of prostaglandin synthesis but may be associated with gastrointestinal, renal, and platelet-related adverse effects. Intravenous paracetamol has emerged as an effective alternative with rapid onset of action, predictable analgesic effect, and a favourable safety profile. Pre-emptive analgesia aims to reduce postoperative pain by administering analgesic agents before surgical stimulation and preventing central sensitization. The present study was undertaken to compare the analgesic efficacy and safety of pre-emptive intravenous diclofenac and intravenous paracetamol in patients undergoing laparoscopic surgeries under general anaesthesia. Material and Methods: This prospective, randomized, double-blind, controlled clinical study was conducted after approval from the Institutional Ethics Committee. Written informed consent was obtained from all patients. A total of 120 adult patients of either sex, belonging to American Society of Anesthesiologists (ASA) physical status I or II, aged between 18 and 60 years, weighing 50–80 kg, scheduled for elective laparoscopic surgeries under general anaesthesia were included. Patients with known allergy or hypersensitivity to paracetamol or diclofenac, chronic analgesic use, significant hepatic or renal dysfunction, coagulation abnormalities, peptic ulcer disease, NSAID-induced bronchial asthma, pregnancy, and patients requiring conversion from laparoscopic to open surgery were excluded. Patients were randomly allocated into two groups of 60 patients each. Group P (Paracetamol group): Patients received intravenous paracetamol 1 g diluted in 100 mL normal saline, administered over 15 minutes, 30 minutes before induction of general anaesthesia. Group D (Diclofenac group): Patients received intravenous diclofenac sodium 75 mg diluted in 100 mL normal saline, administered over 15 minutes, 30 minutes before induction of general anaesthesia. The study medications were prepared by an anaesthesiologist not involved in patient assessment to maintain blinding. Postoperative pain was assessed using the Visual Analogue Scale (VAS). Rescue analgesic requirement and adverse effects were recorded. Results: The demographic characteristics including age, sex, body weight, ASA physical status, duration of surgery, and type of laparoscopic procedure were comparable between the two groups. Both intravenous paracetamol and intravenous diclofenac provided effective postoperative analgesia. Mean VAS scores at different postoperative time intervals were comparable between the groups, with no statistically significant difference. The requirement for rescue analgesia during the postoperative period was similar in both groups. Minor adverse effects such as nausea and vomiting were observed in both groups, with no significant difference. Conclusion: Pre-emptive administration of intravenous paracetamol and intravenous diclofenac provides comparable postoperative analgesia in patients undergoing laparoscopic surgeries under general anaesthesia. Intravenous paracetamol can be considered an effective alternative to diclofenac as a component of multimodal analgesia, particularly in patients where NSAIDs are contraindicated or require cautious use.

Keywords: Intravenous paracetamol; Diclofenac sodium; Pre-emptive analgesia; Laparoscopic surgery; Postoperative pain; General anaesthesia; Multimodal analgesia.