|Abstract:||During the heart operation, a successful analgesia can not only prevent patients’ discomfort, but also reduce morbidity as well as the duration of hospitalisation and therefore reduce the overall treatment costs. One of the methods in the multimodal approach to anaesthesia after the heart surgery, is to add nonsteroidal antirheumatics to opioid analgesics. The use of nonsteroidal antirheumatics results in decreased consumption of opioid analgesics and their potential side effects after the surgery, however their usage can contribute to increased bleeding, impaired kidney function and possible ischemic events.
The aim of the study is to establish weather using diclofenac reduces the usage of opioids and their resulting side effects. Consequences of the diclofenac usage on increased bleeding and impaired thrombocyte function, after the coronary artery bypass grafting (CABG surgery) with the use of extracorporeal circulation, were also examined.
In the controlled, randomized, single-blind study, a total of 72 patients were divided in two groups. One of the groups was administered two 75 mg doses of diclofenac Neodolpasse in the form of 250 ml intravenous therapy (IV). The first dose was given three hours and the next one 12 hours after the first. The control group was administered two doses of 250 ml saline solution IV in the same time intervals. For analgesia, both groups were prescribed 5 mg of opioid analgesics Dipidolor (piritramid), every 8 hours, with increased dosage if needed.
Opioid consumption, blood coagulation, thrombocyte function, rate of bleeding and usage of blood product were recorded after the surgery on all patients. Furthermore, possible increase of urea, creatinine or troponin were closely monitored. The data analysis was performed using suitable statistical tests, with p < 0.05 being set as the p-value.
The study concluded that patients, administered with diclofenac after the heart surgery, did not consume less opioid analgesics and did not exhibit less symptoms linked to their consumption. Moreover, the time span of the respiratory tube usage and the duration of the time spend in intensive hospital care, were not reduced. In the assessment of platelet function tests, we did not detect impaired platelet aggregation in the group that received diclofenac. Likewise, the diclofenac group did not have increased bleeding and increased consumption of blood products in the early postoperative period.|