Perioperative blood loss and diclofenac in major arthroplastic surgery

Abstract

Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.
Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg) and also as intramuscular injection (75 mg) preoperatively and 12 hours later on a day of surgery.
Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05) compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.
Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac) before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.