Diclofenac Sodium versus Fentanyl for Analgesia in Laparoscopic Sterilization

Pain is a marked feature of laparoscopic tubal ligation. Effective postoperative analgesia would make the procedure more acceptable for day-case anaesthesia. An analgesic suitable for day-case anaesthesia needs to provide analgesia without prolonging recovery or producing other adverse events such as nausea and vomiting. In the attempt to identify such an analgesic the authors obtained informed oral consent from 80 patients to compare the effectiveness of diclofenac sodium versus fentanyl for analgesia in laparoscopic sterilization. Both drugs were administered preoperatively by intramuscular injection to the gluteal region diclofenac sodium to 40 women and fentanyl to the remaining 40. Patients were subsequently sterilized by application of Falope rings to the Fallopian tubes. Postoperative pain was marked and both drugs provided only partial relief. Patients in the diclofenac group had pain scores which were initially higher than those in the fentanyl group and the difference between the groups was statistically significant. Patients in the diclofenac group who received postoperative supplemental morphine analgesia recorded lower pain scores at 30 minutes than comparable patients in the fentanyl group. Findings suggest that neither drug provides sufficient analgesia for laparoscopic sterilization when given as a sole analgesic. This warrants the investigation into a combined analgesic technique employing morphine and a nonsteroidal anti-inflammatory drug.