Prospective comparative study of use of diclofenac suppository (150 mg) and intramuscular diclofenac (75 mg) for pain management of patients in post-operative laparoscopic cholecystectomy


  • Alquama Naz Department of General Surgery, SSKM and IPGMER Hospital, Kolkata, West Bengal, India
  • Imdadul Haque Department of General Surgery, ESIPGIMSR & ESIC Medical College, Kolkata, West Bengal, India
  • Prasanto Kumar Roy Department of General Surgery, Malda Medical College, Malda, West Bengal, India
  • Komal Prasad Devangan Department of General Surgery, Chattisgarh Institute of Medical Sciences, Chattisgarh, India



Diclofenac suppositories, Laparoscopic cholecystectomy, Post operative pain


Background: Laparoscopic cholecystectomy is a gold standard surgical procedure for treatment of gallstone disease. Early postoperative pain management will lead to early ambulation, early recovery. This study will help us to make a conclusion whether to use rectal suppositories of NSAIDS as effective alternative to intramuscular injection of NSAIDS for postoperative pain management and recovery of the patients in laparoscopic cholecystectomy. Rationale of this study is to check the effectiveness of Diclofenac rectal suppositories on postoperative patients for pain and morbidity.

Methods: Study was conducted in 50 patients. Diclofenac 150mg suppository (one and half) introduced per rectally at the time of induction of anaesthesia in 25 patients and in another group, 75 mg diclofenac injection given intramuscularly at the time of induction of anaesthesia in another 25 patients. Only single dose of diclofenac  administered. For any pain complaints (VAS >3), a dose of intravenous paracetamol 1 gram was given SOS with minimum interval of 6 hours in both group. Readings was taken at an interval of 6, 12 and 24 hours postoperatively.

Results: There is significant reduction in postoperative pain in group A compare to group B according to VAS with significant p value (0.005 in 6 hours, <0.001 in 12 hours and <0.001 in 24 hours postoperatively). % of decrease in VAS is more in group A with p value 0.001 in 12 hours and 0.004 in 24 hours postoperatively.

Conclusions: In conclusion per rectal suppository of diclofenac for Laparoscopic cholecystectomy reduces pain in the initial postoperative period, it is easy to administer with no adverse effects and may become routine practice for this procedure. This simple, safe, inexpensive, effective form of diclofenac thus improve postoperative analgesia in hospital course. We advocate its use in all elective laparoscopic cholecystectomies.


Vecchio R, MacFayden BV, Palazzo F. History of laparoscopic surgery. Panminerva Med. 2000;42(1):87- 90.

Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993;77(5):1049.

Dionigi R, Dominioni L, Benevento A, Giudice G, Cuffari S, Bordone N, et al. Effects of surgical trauma of laparoscopic vs. open cholecystectomy. Hepato-gastroenterol. 1994;41(5):471-6.

van Hoogdalem EJ, de Boer AG, Breimer DD. Pharmacokinetics of rectal drug administration, part I: general considerations and clinical applications of centrally acting drugs. Cli Pharmacok. 1991;21(1):11-26.

Iqbal MS, Choudry ZA, Nadeem M, Zafar S, Huda NU. Comparison of postoperative outcome with diclofenac rectal suppositories versus intramuscular diclofenac in patients undergoing laparoscopic cholecystectomy. Ann Punjab Medi Coll. 2020;14(2):179-82.

Pal A, Biswas J, Mukhopadhyay P, Sanyal P, Dasgupta S, Das S. Diclofenac is more effective for post-operative analgesia in patients undergoing lower abdominal gynaecological surgeries: A comparative study. Anesth Essays Res. 2014;8(2):192.

Joshi VS, Vyavahare RD, Khade DS, Jamadar NP. Comparative study of analgesic efficacy of rectal suppository of tramadol versus diclofenac in suppressing postoperative pain after Cesarean section. Int J Health Care Biomed Res. 2013;1(2):32-7.

Melzack R. Psychological aspects of pain: Implications for neural blockade. Neural Blockade in Clinical Anesthesia and Management of Pain. 2nd ed. Philadelphia: J.B. Lippincott; 1989:845-60.

Woolf CJ, Chong MS. Pre-emptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77(2):362-79.

Wall PD. The prevention of postoperative pain. Pain 1988;33(3):289-90.

Saxena PK, Golandaj VK., Malviya VK. Epidemiological study in operated patients with cholelithiasis and analysis of risk factors. Surgical Update: Int J surg Orthoped. 2019;5(5):340-5.

Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87.

Bergman S, Sourial N, Vedel I, Hanna WC, Fraser SA, Newman D, et al. Gallstone disease in the elderly: are older patients managed differently? Surg Endoscop. 2011;25(1):55-61.

Adarsh E, Mane R, Sanikop C, Sagar S. Effect of pre-operative rectal diclofenac suppository on post-operative analgesic requirement in cleft palate repair: a randomised clinical trial. Ind J Anaesth. 2012;56(3):265.

Ali A. Efficacy of pre-operative rectal diclofenac suppository for postoperative pain management in laparoscopic cholecystectomy: a multicenter prospective randomized controlled trial. Pak J Medi Heal Sci. 2019;13:890-5.

Patila S, Pandeya V, Pandava N, Inglea M, Phadkea M, Sawanta P. Role of rectal diclofenac suppository for prevention and its impact on severity of post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients. Gastroenterol Res. 2016;9(2-3):47.

Mahdavi A, Telkabadi Z, Aleyasin A, Hosseini MA, Safdarian L and Momenzadeh A. Comparison of morphine suppository and diclofenac suppository for pain management after elective caesarean section. Acta Medica Iran. 2016;54(11):706-12.

Bakhsha F, Niaki AS, Jafari SA, Yousefi Z and Aryaie M. The effects of diclofenac suppository and intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia during cesarean section. J Clin Diagnos Res. 2016;10(7):UC09-UC12.

Kitaya K, Tada Y, Hayashi T, Taguchi S, Funabiki M, Iwaki Y, et al. Diclofenac suppository pretreatment in prevention of vasovagal reflex-associated complications for infertile women undergoing local endometrial injury. Clin Exp Obstet Gynecol. 2015;42(6):723-4.

Amminnikutty CM, Karthik A and Kodakkat AK. Postoperative analgesia in pediatric herniotomy - Comparison of caudal bupivacaine to bupivacaine infiltration with diclofenac suppository. Anesth Essays Res. 2016;10(2):250-4.

Rahimi M, Kazemeini AR, Pourtabatabaei N and Honarmand AR. Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial. Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial. Surg today. 2012;42(12):1201-5.






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