The Efficacy of Systemic Transdermal Diclofenac Patch for Postoperative Pain After Lumbar Spinal Surgery.

Abstract

A single-center, prospective, comparative study. This study aimed to investigate the efficacy and safety of the systemic transdermal diclofenac patch (DP) for immediate postoperative analgesia after lumbar spinal surgery. Effective wound pain control after spinal surgery has been shown to lead to favorable outcomes. Using multimodal analgesia may decrease opioid use for postoperative pain. Patients who underwent posterior lumbar spinal surgery between August 2022 and January 2023 were divided into 2 groups: patients who underwent surgery on even months and were treated with DP (DP [+] group) and those who underwent surgery on odd months and were not treated with DP (DP [-] group). The demographic data, morphine milligram equivalent (MME) within 24 hours, duration of hospitalization, number of rescue analgesics used, visual analog scale (VAS) scores of wound pain, deterioration in renal function, and other complications were compared. Subgroup analysis consisted of subgroups categorized based on surgical procedure (nonfusion or fusion surgery). In total, 111 and 113 patients were enrolled in the DP (+) and DP (-) groups, respectively. There was no significant difference in the deterioration of renal function in the DP (+) group. Overall comparisons demonstrated a significant difference between the DP (+) and DP (-) groups in the number of rescue analgesics used within 1 hour ( P =0.046). In the nonfusion surgery subgroups, the MMEs within 24 hours, the number of rescue analgesics used within 1 and 3 hours, as well as the wound pain VAS at 1 and 3 hours postoperatively were significantly lower in the DP (+) group than in the DP (-) group ( P =0.010, 0.015, 0.029, 0.005, and 0.048, respectively). Systemic transdermal DP may potentially offer safe and effective postoperative analgesia, especially in less invasive procedures, such as nonfusion lumbar spinal surgery. Level III.