This randomised double- blind study was designed to compare preemptive analgesic efficacy of acetaminophen, diclofenac and combination of both, administered orally in patients undergoing elective modified radical mastectomy. One hundred and twenty female patients of American Society of Anaesthesiologists physical status I-III scheduled for modified radical mastectomy surgery under general anesthesia were randomized according to a computer generated randomization schedule into four groups of 30 each to receive orally either acetaminophen 10mg/kg ( Group I ), diclofenac 1mg/kg ( Group II), combination of acetaminophen 10mg/kg and diclofenac 1mg/kg(Group III) or placebo ( Group IV) 1 hr before surgery. The rescue analgesia was provided with morphine postoperatively. In the first 24 hours of postoperative period, intensity of pain, time and dose to first rescue analgesia and total analgesic requirement were recorded. Dose of first rescue analgesic, mean VAS, mean morphine and total morphine requirements were lowest in combination group. Time to first rescue analgesic was prolonged in diclofenac and combination group as compared with acetaminophen and placebo. Global satisfaction score as regard to postoperative pain at 12 hours and 24 hours were significantly better in combination and diclofenac group as compared to acetaminophen and placebo. In conclusion, combination of acetaminophen and diclofenac sodium forms a superior analgesic for postoperative pain management as compared to individual drugs. Diclofenac and acetaminophen have a definitive opioid sparing effect but diclofenac possesses better pre-emptive analgesic efficacy than acetaminophen.
