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NSAID — Perioperative Analgesia

Diclofenac (Perioperative)

Brand names: Voltarol, Diclofenac SR

Diclofenac is a non-steroidal anti-inflammatory drug used perioperatively for moderate postoperative pain and as part of opioid-sparing multimodal analgesia.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis to produce analgesic and anti-inflammatory effects.

Prescribing in practice

  • Avoid in patients with renal impairment, hypovolaemia or significant cardiovascular disease, as perioperative NSAIDs risk acute kidney injury and diclofenac carries the highest cardiovascular thrombotic risk of the traditional NSAIDs.
  • It increases gastrointestinal and surgical-site bleeding risk through platelet inhibition and mucosal injury, so consider gastroprotection and the procedure's bleeding profile.
  • Avoid in active peptic ulceration, severe heart failure and in those with aspirin- or NSAID-sensitive asthma.

Monitoring

Monitor renal function, blood pressure, fluid balance and for signs of gastrointestinal or surgical bleeding.

Counselling the patient

  • Take with or after food and report indigestion, black stools or reduced urine output.
  • Avoid other anti-inflammatory painkillers at the same time.

Evidence & guidelines

Perioperative NSAID use for opioid-sparing analgesia is supported by NICE acute pain guidance, with cardiovascular cautions reflecting MHRA advice.

Reference: MHRA Drug Safety Update 2013; PROSPECT Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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