The Efficacy of Systemic Transdermal Diclofenac Patch for Postoperative Pain after Lumbar Spinal Surgery.

STUDY DESIGN: A single-center, prospective, comparative study. OBJECTIVE: This study aimed to investigate the efficacy and safety of the systemic transdermal diclofenac patch (DP) for immediate postoperative analgesia after lumbar spinal surgery. SUMMARY OF BACKGROUND DATA: Effective wound pain control after spinal surgery has been shown to lead to favorable outcomes. Using multimodal analgesia may decrease opioid use for postoperative pain. MATERIALS AND METHODS: Patients who underwent posterior lumbar spinal surgery between August 2022 and January 2023 were divided into two groups: patients who underwent surgery on even months and were treated with DP (DP [+] group) and those who underwent surgery on odd months and were not treated with DP (DP [-] group). The demographic data, morphine milligram equivalent (MMEs) within 24 hours, duration of hospitalization, number of rescue analgesics used, visual analog scale (VAS) scores of wound pain, deterioration in renal function, and other complications were compared. Subgroup analysis consisted of subgroups categorized based on surgical procedure (non-fusion or fusion surgery). RESULTS: In total, 111 and 113 patients were enrolled in the DP (+) and DP (-) groups, respectively. There was no significant difference in the deterioration of renal function in the DP (+) group. Overall comparisons demonstrated a significant difference between the DP (+) and DP (-) groups in the number of rescue analgesics used within 1 hour (P=0.046). In the non-fusion surgery subgroups, the MMEs within 24 hours, the number of rescue analgesics used within 1 and 3 hours, as well as the wound pain VAS at 1 and 3 hours postoperatively were significantly lower in the DP (+) group than in the DP (-) group (P=0.010, 0.015, 0.029, 0.005, and 0.048 respectively). CONCLUSION: Systemic transdermal DP may potentially offer safe and effective postoperative analgesia, especially in less invasive procedures such as non-fusion lumbar spinal surgery. LEVEL OF EVIDENCE: Level III.

"Brief" Aripiprazole-induced Neuroleptic Malignant Syndrome with Symptoms that Only Lasted a Few Hours.

Neuroleptic malignant syndrome (NMS) with characteristic symptoms is a potentially lethal reaction to antipsychotic drugs. Atypical NMS usually lacks major symptoms and frequently occurs after treatment using atypical antipsychotics, such as aripiprazole. A 64-year-old man developed aripiprazole-induced NMS after surgery, and our early recognition of the NMS was based on high creatine kinase levels and low serum iron levels. His characteristic symptoms (a fever, rigidity, and altered mental status) were only present for a few hours and were resolved by aripiprazole discontinuation and supportive care. Aripiprazole-induced NMS can present with brief but major symptoms, and clinicians may overlook this "brief" appearance of NMS.