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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Diclofenac Does Not Decrease Renal Blood Flow or Glomerular Filtration In Elderly Patients Undergoing Orthopedic Surgery

Brian Fredman, MB BCh^*, Edna Zohar, MD^*, Eli Golan, MD, Michael Tillinger, MD^*, Jacques Bernheim, MD, and Robert Jedeikin, BSc, MBChB, FFA(SA)^*

Departments of *Anesthesiology and Intensive Care and Nephrology, Meir Hospital, Kfar Saba; and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Address correspondence and reprint requests to Professor Robert Jedeikin, Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba 44281, Israel.

Nonsteroidal antiinflammatory drugs (NSAIDs) have become increasingly popular in the treatment of perioperative pain. Due to concerns that cyclooxygenase inhibition may adversely affect renal function, these drugs are often not used in geriatric surgical patients. However, the perioperative effect of NSAIDs on renal blood flow (RBF) and glomerular filtration rate (GFR) has not been assessed. Therefore, using a prospective, controlled, double-blinded study design, we evaluated the effect of diclofenac on RBF and GFR in 20 patients (>65 yr) undergoing open reduction and internal fixation of the femur. All patients were normovolemic before the study. A standardized general anesthetic was administered. On induction of anesthesia, patients in the diclofenac group received an IV bolus of diclofenac (0.7 mg/kg) followed by a constant infusion (0.15 mg · kg^-1 · h^-1) until the end of surgery. In the saline group, an equal volume of saline was administered. During four time periods (equilibration, anesthesia, surgical, recovery), GFR and effective renal plasma flow (ERPF) were measured by inulin and paraaminohippurate clearance, respectively. After the induction of anesthesia and throughout the surgical period, ERPF and GFR were significantly decreased compared with preoperative baseline values. However, no difference was demonstrated between the groups. These results suggest that, in geriatric surgical patients, the adjuvant administration of NSAIDs does not adversely affect renal function.

Implications: As determined by inulin and paraaminohippurate clearance, the intraoperative administration of diclofenac does not decrease glomerular filtration rate or effective renal plasma flow in normovolemic geriatric patients. Therefore, diclofenac may be administered during the perioperative period.