Efficacy of Diclofenac and Ketoprofen Transdermal Patches for Postoperative Analgesia and their Effect on Renal Functions in Patients Undergoing Percutaneous Nephrolithotomy: A Randomised Clinical Study

Introduction: Postoperative pain management following Percutaneous Nephrolithotomy (PCNL) is critical for patient comfort and recovery. Ketoprofen transdermal patches, a recent addition to Non Steroidal Anti-Inflammatory Drug (NSAID) analgesia, may offer better tolerability and analgesic efficacy compared to diclofenac patches. Aim: To compare the efficacy of diclofenac versus ketoprofen patches for postoperative analgesia and their effects on serum creatinine in patients undergoing PCNL. Materials and Methods: This double-blind, randomised clinical study included 52 patients (aged 18–60 years, American Society of Anaesthesiologists (ASA) I–II) undergoing elective PCNL at a tertiary care centre. Patients were randomly assigned to Group K (n=26, 30 mg ketoprofen patch) or Group D (n=26, 100 mg diclofenac patch). Patches were applied 30 minutes before the end of surgery. Pain was assessed using the Visual Analog Scale (VAS) at 0, 4, 8, 12, 16, 24 and 48 hours. Rescue analgesia (tramadol 50 mg) was administered for VAS ≥ 5. Serum creatinine was measured preoperatively and at 24 hours postoperatively. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0, with p-value <0.05 considered significant. Results: Baseline demographics, including age, gender and ASA grading, were comparable between the groups. Group K had significantly lower VAS scores at eight hours (3.1±1.1 vs. 4.19±0.56; p-value <0.001), 24 hours (2.65±0.68 vs. 3.35±0.48; p-value <0.001) and 48 hours (2.4±0.5 vs. 3±0.74; p-value=0.002). More patients in Group D required rescue analgesia at four hours (p-value=0.009). Group D showed a statistically significant rise in serum creatinine postoperatively (p-value=0.02), while Group K did not (p-value=0.057). The incidence of headaches was higher in Group D (19.2%), with fewer overall side-effects reported in Group K (p-value=0.05). Conclusion: Ketoprofen patches provided superior analgesia and fewer adverse effects compared to diclofenac in postPCNL patients. Both drugs demonstrated comparable renal safety over 24 hours. Ketoprofen may be a better alternative for transdermal analgesia in this setting.