Fixed combination of diclofenac and orphenadrine (Neodolpasse) for postoperative pain relief. Review of the results of international and Russian studies

Sorokina L.S.; Vyzhigina M.A.; Semenkov M.A.; Arkhipova O.V.; Eremenko A.A.

doi:https://doi.org/10.17116/anaesthesiology202403174

Sorokina L.S.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-5809-8563

Vyzhigina M.A.

Petrovsky Russian Scientific Center of Surgery;
Sechenov First Moscow State Medical University

ORCID: 0000-0002-6024-0191

Semenkov M.A.

Pirogov Russian National Research Medical University

ORCID: 0009-0003-3453-8669

Arkhipova O.V.

Pirogov Russian National Research Medical University

ORCID: 0009-0005-3266-6872

Eremenko A.A.

Petrovsky Russian Scientific Center of Surgery;
Sechenov First Moscow State Medical University

ORCID: 0000-0001-5809-8563

Fixed combination of diclofenac and orphenadrine (Neodolpasse) for postoperative pain relief. Review of the results of international and Russian studies

Authors:

Sorokina L.S., Vyzhigina M.A., Semenkov M.A., Arkhipova O.V., Eremenko A.A.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2024;(3): 74‑80

DOI: 10.17116/anaesthesiology202403174

Read: 1371 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Sorokina LS, Vyzhigina MA, Semenkov MA, Arkhipova OV, Eremenko AA. Fixed combination of diclofenac and orphenadrine (Neodolpasse) for postoperative pain relief. Review of the results of international and Russian studies. Russian Journal of Anesthesiology and Reanimatology. 2024;(3):74‑80. (In Russ.)
https://doi.org/10.17116/anaesthesiology202403174

Использование инфографики авторами научных работ

Close metadata

Recommended articles:

Novel opioids in postoperative pain management. Russian Journal of Anesthesiology and Reanimatology. 2025;(3):78-84

Transitional pain service in surgery as an optimal strategy for the treatment and prevention of chronic postoperative pain. Pirogov Russian Journal of Surgery. 2024;(11):60-64

Reflexotherapy as an effective component of postoperative pain relief. Russian Journal of Pain. 2024;(4):41-45

Psychosensory anatomo-functional autodesadaptation syndrome as a predictor of pain in patients after orthognathic surgery. Russian Rhinology. 2025;(1):42-47

Use of a fixed combination of diclofenac and orphenadrine (Neodolpasse) for postoperative analgesia after extended gastrectomy with resection of the lower third of the esophagus. P.A. Herzen Journal of Oncology. 2025;(2):52-56

Abstract:

Postoperative pain remains a significant problem for many patients and is underestimated. Currently, a multimodal approach is considered conventional, involving the simultaneous administration of multiple medicine or the fixed combinations, enabling the reduction of doses, achieving maximum opioid-sparing effect, and decreasing complications associated with analgesic therapy. However, many issues regarding the selection of analgesic therapy included in these regimens remain debatable. This article is the overview of the international and Russian publications dedicated to the study of the pharmacological properties, effectiveness, and tolerability of fixed combination of diclofenac 75 mg and orphenadrine 30 mg for i.v. infusion. The data from the studies conducted in patients in the early postoperative period after various surgical interventions are discussed, including cardiothoracic, abdominal, trauma and orthopedic surgeries (vertebroplasty, joint replacement surgery). The results of shot course infusion demonstrates high analgesic effectiveness, opioid-sparing effect, good tolerability in moderate to severe acute postoperative pain.

Keywords:

postoperative pain

multimodal analgesia

opioids

fixed combination of diclofenac and orphenadrine

Authors:

Sorokina L.S.

Petrovsky National Research Center of Surgery

ORCID: 0000-0001-5809-8563

Vyzhigina M.A.

Petrovsky Russian Scientific Center of Surgery;
Sechenov First Moscow State Medical University

ORCID: 0000-0002-6024-0191

Semenkov M.A.

Pirogov Russian National Research Medical University

ORCID: 0009-0003-3453-8669

Arkhipova O.V.

Pirogov Russian National Research Medical University

ORCID: 0009-0005-3266-6872

Eremenko A.A.

Petrovsky Russian Scientific Center of Surgery;
Sechenov First Moscow State Medical University

ORCID: 0000-0001-5809-8563

Received:

19.03.2024

Accepted:

05.04.2024

Close metadata

References:

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC, van den Boogaard M, Bosma KJ, Brummel NE, Chanques G, Denehy L, Drouot X, Fraser GL, Harris JE, Joffe AM, Kho ME, Kress JP, Lanphere JA, McKinley S, Neufeld KJ, Pisani MA, Payen JF, Pun BT, Puntillo KA, Riker RR, Robinson BRH, Shehabi Y, Szumita PM, Winkelman C, Centofanti JE, Price C, Nikayin S, Misak CJ, Flood PD, Kiedrowski K, Alhazzani W. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine. 2018;46(9):e825-e873. https://doi.org/10.1097/CCM.0000000000003299
Martyn JAJ, Mao J, Bittner EA. Opioid Tolerance in Critical Illness. New England Journal of Medicine. 2019;380(4):365-378. https://doi.org/10.1056/NEJMra1800222
Dahl JL, Gordon D, Ward S, Skemp M, Wochos S, Schurr M. Institutionalizing pain management: The Post-Operative Pain Management Quality Improvement Project. Journal of Pain. 2003;4(7):361-371. https://doi.org/10.1016/S1526-5900(03)00640-0
Shang AB, Gan TJ. Optimising postoperative pain management in the ambulatory patient. Drugs. 2003;63(9):855-867. https://doi.org/10.2165/00003495-200363090-00002
Drew D, Gordon D, Renner L, Morgan B, Swensen H, Manworren R. The Use of “As-Needed” Range Orders for Opioid Analgesics in the Management of Pain: A Consensus Statement of the American Society of Pain Management Nurses and the American Pain Society. Pain Management Nursing. 2014;15(2):551-554. https://doi.org/10.1016/j.pmn.2014.03.001
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Committee on Regional Anesthesia, Executive Committee, and Administrative Council. Pain. 2016;17(2):131-157. https://doi.org/10.1016/j.jpain.2015.12.008
Ma CH, Tworek KB, Kung JY, Kilcommons S, Wheeler K, Parker A, Senaratne J, Macintyre E, Sligl W, Karvellas CJ, Zampieri FG, Kutsogiannis DJ, Basmaji J, Lewis K, Chaudhuri D, Sharif S, Rewa OG, Rochwerg B, Bagshaw SM, Lau VI. Systemic Nonsteroidal Anti-Inflammatories for Analgesia in Postoperative Critical Care Patients: A Systematic Review and Meta-Analysis of Randomized Control Trials. Critical Care Explorations. 2023;5(7):e0938. https://doi.org/10.1097/CCE.0000000000000938
Todd PA, Sorkin EM. Diclofenac sodium. A reappraisal of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy. Drugs. 1988;35(3):244-285. https://doi.org/10.2165/00003495-198835030-00004
Barden J, Edwards J, Moore RA, McQuay HJ. Single dose oral diclofenac for postoperative pain. The Cochrane Database of Systematic Reviews. 2004; 2:CD004768. https://doi.org/10.1002/14651858.CD004768
McNicol ED, Ferguson MC, Schumann R. Single-dose intravenous diclofenac for acute postoperative pain in adults. The Cochrane Database of Systematic Reviews. 2018;8(8):CD012498. https://doi.org/10.1002/14651858.CD012498.pub2
Gan TJ, Daniels SE, Singla N, Hamilton DA, Carr DB. A novel injectable formulation of diclofenac compared with intravenous ketorolac or placebo for acute moderate-to-severe pain after abdominal or pelvic surgery: A multicenter, double-blind, randomized, multiple-dose study. Anesthesia and Analgesia. 2012;115(5):1212-1220. https://doi.org/10.1213/ANE.0b013e3182691bf9
Schjerning AM, McGettigan P, Gislason G. Cardiovascular effects and safety of (non-aspirin) NSAIDs. Nature Reviews Cardiology. 2020;17(9):574-584. https://doi.org/10.1038/s41569-020-0366-z
Grosser T, Fries S, FitzGerald GA. Biological basis for the cardiovascular consequences of COX-2 inhibition: therapeutic challenges and opportunities. The Journal of Clinical Investigation. 2006;116(1):4-15. https://doi.org/10.1172/JCI27291
Da Costa BR, Reichenbach S, Keller N, Nartey L, Wandel S, Jüni P, Trelle S. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: A network meta-analysis. Lancet. 2017;390(10090):e21-e33. https://doi.org/10.1016/S0140-6736(17)31744-0
Schaffler K, Reitmeir P, Gschanes A, Eggenreich U. Comparison of the analgesic effects of a fixed-dose combination of orphenadrine and diclofenac (Neodolpasse) with its single active ingredients diclofenac and orphenadrine: A placebo-controlled study using laser-induced somatosensory-evoked potentials from capsaicin-induced hyperalgesic human skin. Drugs in R and D. 2005;6(4):189-199. https://doi.org/10.2165/00126839-200506040-00001
Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. British Journal of Anaesthesia. 2002;89:409-423. https://doi.org/10.18821/1993-6508-2016-10-1-40-46
Karim Z, Schug SA. Function in Response to Acute Pain. In: Encyclopedia of Pain. Schmidt RF, Willis WD, eds. Berlin, Heidelberg: Springer; 2006.
Ovechkin AM, Bayaliyeva AZ, Yezhevskaya AA, Eremenko AA, Zabolotskij DV, Zabolotskikh IB, Karelov AE, Koryachkin VA, Spasova AP, Khoronenko VE, Uvarov DN, Ulrikh GE, Shadrin RV. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019;4:9-33. (In Russ.). https://doi.org/10.21320/1818-474X-2019-4-9-33
Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, Dunning J, Gudbjartsson T, Linker NJ, Sandoval E, Thielmann M, Jeppsson A, Landmesser U. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2017;53(1):15-33. https://doi.org/10.1093/ejcts/ezx314
Eremenko AA, Sorokina LS. Anesthesia of adult patients in the early period after cardiac surgery. Rossijskij zhurnal boli. 2018;55(1):21-27. (In Russ.). https://doi.org/10.25731/RASP.2018.01.004
Osojnik I, Kamenik M. The Effect of Diclofenac on Bleeding, Platelet Function, and Consumption of Opioids Following Cardiac Surgery. Brazilian Journal of Cardiovascular Surgery. 2020;35(2):160-168.
Sorokina LS, Ryabova DV, Koshek EA, Eremenko AA. Efficacy and safety of using a fixed combination of Orphenadrine and Diclofenac for postoperative analgesia in cardiac surgery patients. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2022;122(2):61-67. (In Russ.). https://doi.org/10.17116/jnevro202212202161
Eremenko AA, Sorokina LS, Ryabova DV, Urbanov AV. Analgesic and opioid-sparing effects of a fixed combination of diclofenac and orphenadrine in the early postoperative period in cardiac surgery patients. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2022;122(10):109-115. (In Russ.). https://doi.org/10.17116/jnevro2022122101109
Yavorovskiy AG, Nogtev PV, Ovechkin AM, Bagdasarov PS, Polukhin NV, Sergeev OS, Aliev VA, Zolotova EN, Yavorovskaya DA. Postoperative analgesia with a fixed combination of diclofenac and orphenadrine in thoracic surgery. Russian Journal of Anesthesiology and Reanimatology. 2023;4:81-87. (In Russ.). https://doi.org/10.17116/anaesthesiology202304181
Kurganskiy AV, Khrapov KN. Approaches to post-operative pain relief during total knee and hip replasement. Messenger of Anesthesiology and Resuscitation. 2018;15(4):76-85. (In Russ.). https://doi.org/10.21292/2078-5658-2018-15-4-76-85
Elmallah RK, Cherian JJ, Pierce TP, Jauregui JJ, Harwin SF, Mont MA. New and Common Perioperative Pain Management Techniques in Total Knee Arthroplasty. Journal of Knee Surgery. 2016;29(2):169-178. https://doi.org/10.1055/s-0035-1549027
Málek J, Nedělová I, Lopourová M, Stefan M, Kostál R. [Diclofenac 75 mg. and 30 mg. orfenadine (Neodolpasse) versus placebo and piroxicam in postoperative analgesia after arthroscopy]. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 2004;71(2):80-83. (In Czech).
Gombotz H, Lochner R, Sigl R, Blasl J, Herzer G, Trimmel H. Opiate sparing effect of fixed combination of diclophenac and orphenadrine after unilateral total hip arthroplasty: A double-blind, randomized, placebo-controlled, multi-centre clinical trial. Wiener Medizinische Wochenschrift (1946). 2010;160(19-20):526-534. https://doi.org/10.1007/s10354-010-0829-7
Gukalov AA, Klypa TV, Mandel’ IA, Minets AI. The use of a fixed combination of diclofenac and orphenadrine for postoperative pain relief in orthopedic patients. Khirurgiya. Zhurnal im. N.I. Pirogova. 2023;4:49-54. (In Russ.). https://doi.org/10.17116/hirurgia202304149
Fritsch G, Steltzer H, Oberladstaetter D, Zeller C, Prossinger H. Artificial intelligence algorithms predict the efficacy of analgesic cocktails prescribed after orthopedic surgery. PLoS One. 2023;18(2):e0280995. https://doi.org/10.1371/journal.pone.0280995
Kissin I. Preemptive analgesia at the crossroad. Anesthesia and Analgesia. 2005;100(3):754-756. https://doi.org/10.1213/01.ANE.0000144429.39988.9B
Ballantyne J. Preemptive analgesia: An unsolved problem. Current Opinion in Anaesthesiology. 2001;14(5):499-504. https://doi.org/10.1097/00001503-200110000-00007
Kuzmina MV, Shlyk IV, Panafidina VA, Kozhevin AA, Polushin YuS, Krivov VO. The use of a combination of diclofenac and orphenadrine for analgesia in knee replacement. Messenger of Anesthesiology and Resuscitation. 2023;20(5):48-53. (In Russ.). https://doi.org/10.24884/2078-5658-2023-20-5-48-53
Grecu I, Muresan A, Nicolau M, Grintescu I. Diclofenac/orphenadrine versus paracetamol for analgesia after total hip arthro-plasty. European Journal of Anesthesiology. 2006;23(37):236-237. https://doi.org/10.1097/00003643-200606001-00851
Karelov AE, Khmara VM, Orozaliev IE, Kellarev MV, Petrosyan TG, Karelov DA, Zabolotskii DV. Comparative assessment of analgesic efficacy of diclofenac and orfenadrine combination in abdominal and vertebral surgery. Russian Journal of Anesthesiology and Reanimatology. 2023;5:52-57. (In Russ.). https://doi.org/10.17116/anaesthesiology202305152