Advisability of NSAID combined with central muscle relaxant for pain syndrome after thoracoscopic surgery

Objective. To compare the effectiveness and safety of diclofenac combined with orphenadrine and ketoprofen for postoperative analgesia after elective thoracoscopic surgery. Material and methods. A single-center randomized prospective study included 47 patients divided into 2 groups depending on postoperative analgesia regimen: group 1 (n=25) — Neodolpasse 75 mg (counted for diclofenac) intravenously immediately after surgery and 12 hours later; group 2 (n=22) — ketoprofen 100 mg. Effectiveness of anesthesia was assessed considering VAS scores, the need for opioid analgesics and laboratory criteria (cortisol). Safety implied analysis of serum cystatin C, azotemia, reticulocytosis, platelet count, INR, fibrinogen and D-dimer. Intraoperative anesthesia implied fentanyl 0.1—0.2 mg intravenously. The last injection (0.1 mg) was performed 15—25 min before the end of surgery. The Chi-square test and t-test were used for statistical analysis. Results. Postoperative VAS scores were similar at the first three points (after 3, 6 and 9 hours) (p=0.37, p=0.72 and p=0.23, respectively). There were no between-group differences in serum cortisol (348.24±0.34 and 402.22±0.44 nmol/l, p=0.48) and the need for narcotic analgesics (74.29±30.81 and 57.33±33.69 mg/day, respectively, p=0.084). At the same time, safety profile was comparable. We found no significant differences in hemostasis parameters (platelet count, INR, fibrinogen and D-dimer). However, Neodolpasse was potentially safer regarding the risk of renal dysfunction. Indeed, serum cystatin C after 24-hour treatment was lower in the main group (0.88±0.34 and 1.19±0.44 mg/l, respectively, p=0.031). Conclusion. Neodolpasse is effective for pain relief in various clinical situations including surgery. However, we found no significant differences between this drug and ketoprofen after thoracoscopic interventions. Safety profile of diclofenac combined with orphenadrine was better regarding the risk of kidney damage.