Oral or rectal diclofenac for laparoscopic sterilization

In the UK, perioperative non-steroidal anti-inflammatory drugs are commonly administered via the rectal route even though suppositories are unpopular with patients. This prospective, randomised, double-blind study compares the analgesic effectiveness of diclofenac 100 mg given either orally or rectally to 42 ASA grades 1 and 2 patients scheduled to undergo day-case laparoscopic sterilization by the application of Filshie clips. General anaesthesia was induced with fentanyl 2 μg kg⁻¹ and propofol and maintained with isoflurane and nitrous oxide in oxygen. No difference was observed between the two groups in postoperative pain scores, morphine requirement, nausea and vomiting rates and time to achievement of street fitness. One patient in the rectal group and none in the oral group required in-patient admission. We conclude that oral and rectal diclofenac are of equal effectiveness in this approach to day-case laparoscopic sterilization.