Abstract Title Comparative Evaluation of the Efficacy of Intramuscular versus Transdermal Diclofenac in Post-Operative Pain Management in Modified Radical Mastectomy Patients

Background Postoperative pain management is crucial for patient recovery following surgery, and adequate analgesia can mitigate various physiological and psychological complications. Breast cancer, being a common carcinoma, often requires modified radical mastectomy (MRM), which is associated with significant postoperative pain. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), is widely used for pain management but poses challenges with oral and intramuscular administration due to systemic side effects and local irritation. A newly introduced diclofenac transdermal patch offers an alternative, potentially improving analgesic efficacy and patient compliance.

Methods This study was conducted on 60 patients aged 25-65, classified as ASA grade I and II, scheduled for elective MRM under general anesthesia. Patients were randomly allocated into two groups: Group M (30 patients) received intramuscular diclofenac (75 mg) half an hour before the end of surgery, and Group P (30 patients) received a transdermal diclofenac patch (100 mg) at the beginning of surgery. Preoperative assessments included clinical history, physical examination, and routine laboratory investigations. Postoperative pain was evaluated using the Visual Analog Scale (VAS) at various intervals, and rescue analgesia was administered when VAS scores reached five or more. Additional observations included heart rate, blood pressure, and side effects. Statistical analysis was performed.

Results Both groups were comparable in demographic parameters (age, height, weight, duration of surgery). Postoperative heart rate and blood pressure variations showed no significant differences between the groups. VAS scores revealed statistically significant lower pain levels in Group P at 8 and 12 hours postoperatively (p<0.05). The mean duration of analgesia was significantly longer in Group P (14.28±4.49 hours) compared to Group M (7.91±2.81 hours) (p<0.05). The total dose of rescue analgesia was higher in Group M (1.13±0.34) compared to Group P (1±0) (p<0.05). Side effects were more frequent in Group M, with three patients (10%) reporting adverse events like pain on the injection site and nausea and vomiting, compared to 1 patient (3.3%) in Group P who complained of erythema on the patch site.

Conclusion The diclofenac transdermal patch provides superior postoperative analgesia compared to intramuscular diclofenac, with significantly prolonged pain relief and reduced need for rescue analgesia. Additionally, the patch demonstrated a lower incidence of side effects, making it a more effective and patient-friendly option for managing postoperative pain in patients undergoing MRM. This study supports the adoption of the diclofenac transdermal patch as a viable alternative for postoperative pain management in breast cancer surgeries.