Low-Dose Intramuscular Diclofenac Sodium for Fever Control in Acute Brain Injury.

Objective: To evaluate the cerebral and hemodynamic effects of low-dose intramuscular diclofenac sodium (DCFS) administered for fever control in patients with acute brain injury in the intensive care unit.

Methods: Inclusion criteria for this prospective clinical study were age ≥18 years; the ability to monitor intra-arterial blood pressure, core body temperature, and intracranial pressure; the placement of an indwelling jugular venous catheter for intermittent jugular venous oxygen saturation measurements; and a core body temperature ≥37.5°C. Exclusion criteria were hypovolemia, administration of drugs with hemodynamic effects during the study period, administration of antipyretics within 6 hours before the start of the study, acute heart failure, cerebral vasospasm, pregnancy, renal and gastric diseases, and allergy to DCFS.

Results: The study enrolled 30 patients with acute brain injury. Two We observed statistically significant decreases in core body temperature (P < 0.001), systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), mean arterial pressure (P < 0.001), heart rate (P < 0.001), and cerebral perfusion pressure (P < 0.001) 2 hours after DCFS administration with respect to baseline (T0). The dosage of noradrenaline (norepinephrine) in subjects receiving treatment at the start of the study increased significantly from 0.14 μg/kg/minute ± 0.1 to 0.20 μg/kg/minute ± 0.1 (P = 0.0395).

Conclusions: Low-dose intramuscular DCFS administration for fever control in patients with acute brain injury is effective but also exposes patients to potentially deleterious hypotensive episodes that must be diagnosed and treated expeditiously to prevent further damage to the injured brain.