Background: 

The use of nonsteroidal anti-inflammatory drugs in neurosurgery remains controversial because of potential risk of hematoma formation secondary to platelet dysfunction. This study aimed to investigate the efficacy and safety of diclofenac compared with paracetamol for the management of postcraniotomy pain.

Methods: 

In all, 110 adult patients undergoing craniotomy for supratentorial tumors were randomized to receive either intravenous paracetamol (15 mg/kg) or intravenous diclofenac sodium (1.5 mg/kg) 30 minutes before the end of surgery and postoperatively at 12-hour intervals up to 48 hours. The analgesic efficacy of diclofenac and paracetamol was assessed using the Numerical Rating Scale (NRS) score at 12, 24, and 48 hours after surgery. We also examined the need for rescue analgesia, coagulation profiles using a Sonoclot analyzer, and incidence of intracranial hematoma formation.

Results: 

At 24 hours postsurgery, NRS scores were lower in group D than in group P; median (interquartile range) and mean rank NRS score in group D was 3.00 (1.0), 43.71, respectively, compared with 3.00 (1.0), 59.29 in group P (P=0.004). Patients in group P received more rescue analgesia than those in group D. Coagulation profiles were similar between groups at 24 hours. Activated clotting time was longer in group D (128.76±12.61 s) than in group P (123.84±09.77 s; P=0.03) at 48 hours, although remained within normal limits in both groups; clot rate and platelet function were similar at 48 hours. There was no difference in the incidence of postoperative tumor bed hematoma.

Conclusion: 

Compared with paracetamol, diclofenac sodium provided more effective postoperative analgesia at 24 hours with no evidence of adverse effects on coagulation profiles in patients undergoing craniotomy for supratentorial tumors.

中文翻译：

---

双氯芬酸在幕上开颅术后疼痛评分和镇痛药用量方面优于扑热息痛，血小板和凝块功能无差异：一项前瞻性随机对照试验

背景： 

由于血小板功能障碍导致血肿形成的潜在风险，在神经外科手术中使用非甾体类抗炎药仍存在争议。本研究旨在比较双氯芬酸与扑热息痛治疗开颅术后疼痛的疗效和安全性。

方法： 

总共有 110 名因幕上肿瘤接受开颅手术的成年患者在手术结束前 30 分钟和术后间隔 12 小时接受静脉注射扑热息痛 (15 mg/kg) 或静脉注射双氯芬酸钠 (1.5 mg/kg)，直至48小时。在术后 12、24 和 48 小时，使用数值评定量表 (NRS) 评分评估双氯芬酸和扑热息痛的镇痛效果。我们还检查了抢救镇痛的需要、使用Sonoclot分析仪的凝血曲线以及颅内血肿形成的发生率。

结果： 

术后 24 小时，D 组 NRS 评分低于 P 组；D组中位数（四分位距）和平均秩NRS评分分别为3.00（1.0）、43.71，而P组为3.00（1.0）、59.29（P =0.004）。P 组的患者比 D 组的患者接受了更多的挽救性镇痛。24 小时时各组之间的凝血曲线相似。D组48小时的活化凝血时间（128.76±12.61 s）比P组（123.84±09.77 s；P = 0.03）长，但两组均在正常范围内；48 小时时的凝块率和血小板功能相似。术后瘤床血肿发生率无差异。

结论： 

与扑热息痛相比，双氯芬酸钠在 24 小时提供更有效的术后镇痛，没有证据表明对幕上肿瘤开颅患者的凝血曲线有不良影响。