Comparison of sodium diclofenac, ketamine and propofol with fentanyl and midazolam in balanced anaesthesia

CONTEXT: Analgesia is based on balanced anaesthesia, which is usually maintained by administration of narcotic agents. In some patients, it is not possible to use narcotics. We compared hemodynamic changes, anaesthesia depth, emetic sequelae and post-operative pain between sodium Diclofenac, Ketamine-Propofol (DKP) and Fentanyl-Midazolam (FM). AIMS: The effectiveness of an anaesthetic technique employing sodium was compared against in patients undergoing elective surgery. SETTINGS AND DESIGN: In a clinical trial study, 82 patients who attended for an elective surgery were randomly divided into two groups. MATERIALS AND METHODS: In DKP group pre-medication included Sodium Diclofenac 1 mg/kg and Midazolam 0.02 mg/kg, whereas, in FM group they were Fentanyl 2 μg/kg and Midazolam 0.02 mg/ kg. Anaesthesia induction in both groups was the same. Anaesthesia was conserved in DKP group by using Propofol plus Ketamine infusion plus N(2)O 50% and in FM group with Fentanyl plus Midazolam plus N(2)O 50%. Hemodynamic changes, depth of anaesthesia, nausea and vomiting, post operative analgesic effects were recorded. RESULTS: Hemodynamic changes and depth of anaesthesia were similar throughout the maintenance phase in two groups. In FM group, significant increase in heart rate was recorded in recovery room. Pain score according to visual analogue scale (VAS) and need for analgesics, was significantly more in FM group compared to DKP group (P = 0.000). No patient suffered from nausea, vomiting or hallucinations. CONCLUSIONS: This study revealed that intravenous administration of Sodium Diclofenac along with Ketamine and Propofolplus N(2)O 50% for general anaesthesia provides a balanced anaesthesia as well as hemodynamic stability, and adequate depth of anaesthesia. It also reduces the postoperative pain and need for narcotics. We recommended DKP plus N(2)O 50% method for patients prohibited from opioid administration. It will be an acceptable method in sensitive patients.