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British Journal of Anaesthesia, 1992, Vol. 69, No. 5 451-456
© 1992 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

EFFECT OF DICLOFENAC ON RENAL FUNCTION AND PROSTACYCLIN GENERATION AFTER SURGERY

I. POWER, M.D., F.R.C.ANAES.1,*, A. D. CUMMING, M.D.2 and G. C. PUGH, F.R.C.ANAES.3

1University Department of Anaesthetics, Royal Infirmary of Edinburgh Edinburgh
2University Department of Medicine, Medical Renal Unit, Royal Infirmary of Edinburgh Edinburgh
3Department of Anaesthetics, City Hospital Edinburgh

We have examined the effect of diclofenac on renal function after major surgery in a randomized, double-blind, controlled study of 20 patients undergoing oesophagogastrectomy. Diclofenac 75 mg or placebo was given i.m. 12-hourly for 2 days. l.v. fluid administration was standardized. Renal function was assessed by fluid balance and measurement of serum creatinine and electrolyte concentrations, creatinine and free water clearance, and urinary sodium and potassium excretion. Urinary 6-keto-prostaglandin F1{alpha}(6-keto-PGF1{alpha} was measured by radioimmunoassay to assess renal prostacyclin production. After surgery, 6-keto-PGF1{alpha} production increased, but this did not occur with diclofenac. On the first day after surgery, use of diclofenac was associated with a decreased urine flow rate, decreased urinary sodium and potassium excretion and a tendency to hyperkalaemia. Fruse-mide was required more often in the diclofenac group. One patient was withdrawn from the diclofenac group because of impaired renal function. Urine flow rate and blood potassium concentration should be monitored if diclofenac is used after major surgery (Br. J. Anaesth. 1992; 69: 451–456)

*Present address, for correspondence: Department of Anaesthetics, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN.


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