Recent advances in anesthesia and surgical techniques have resulted in an escalation in surgical procedures worldwide as ambulatory practices, along with increased healthcare costs (Rawal 2001). The concept of ambulatory surgery emerged in the early 1990s to facilitate early recovery and discharge from the hospital and early resumption of normal daily activities following elective surgical procedures (Jafra and Mitra 2018).

In the practice of obstetrics and gynecology, the most prevalent outpatient anesthesia administration is the dilatation and curettage procedure. In this procedure, sedation anesthesia is often administered and propofol is one of the most popular intravenous agents used for this purpose. It requires us to pay as much attention as possible, especially to respiratory depression and cardiovascular collapse that can be induced by medications. The painful nature of the procedure makes the administration of analgesia inevitable during and following the procedure. Hitherto, various analgesia techniques and anesthetics have been utilized. Existing analgesic drugs and applications in the control of perioperative pain continue to develop rapidly.

Wall, Woolf, and Chong hypothesized in their study, which was based on scientific evidence and supported by animal experiment evidence, that a preemptive treatment could prevent the occurrence of central hypersensitivity, reduce the incidence of hyperalgesia, and reduce the intensity of postoperative pain. Remarkably, preemptive treatment is a procedure that starts before a surgical procedure and has been described as an antinociceptive intervention that is more effective than the same practice initiated postoperatively (Wall 1988; Woolf and Chong 1993; Pogatzki-Zahn and Zahn 2006).

We compared the impacts of dexketoprofen trometamol, which is routinely administered preemptively in our clinic for perioperative analgesia, on acute pain in minor gynecological procedures, by comparing it with paracetamol and control group tramadol.

Management of pain during curettage is of great importance for the patient. During dilation and curettage, the pain usually manifests itself in the cervical block injection procedure, with cervical dilation, suction aspiration, and postoperative uterine cramping (Meckstroth and Mıshra 2009). Even with conscious sedation, mean pain scores range from 3.4 to 4.9 at 10 cm on the VAS (visual analog scale) during dilatation, while it ranges from 3.8 to 7.1 cm with curettage (Mankowski et al. 2009). In a report involving 825 women who had a curettage in the first trimester, the mean pain score was determined to be 5.4 on an 11-point scale (Wiebe et al. 2005). Depression and anxiety scores were found to be positively correlated with pain perception (Rawling and Wiebe 2001). This points out the need for better analgesia for the revision curettage procedure. In our study, the younger age of the patients in the dexketoprofen trometamol group and the more intensive revision curettage procedure in this group indicates that more anxious patients and more painful procedures are common compared to the literature. Nevertheless, the similarity of induction and additional doses of propofol administered in all three groups under deep sedation suggests that Dexketoprofen trometamol might play a role in sedation as well as its analgesic activity.

In our study, we assessed the impact of analgesics administered with propofol sedation anesthesia on intraoperative RSS (Ramsey sedation scores). In the study of Yazar et al., in which the postoperative analgesic efficacy of i.v. dexketoprofen trometamol in lumbar disc surgery was assessed, and RSS results were found to be similar to placebo (Yazar et al. 2011). In another study by Hanna et al. in which intramuscular dexketoprofen trometamol was compared with ketoprofen, it was revealed that the 2nd and 13th-hour values of patients who underwent major orthopedic surgery had higher sedation scores for both agents compared to placebo (Hanna et al. 2003). The results of the study conducted by Calvo et al. on dogs demonstrated that dexketoprofen and methadone produced similar sedation during orthopedic surgery with similar isoflurane concentration and similar doses of fentanyl and propofol (Navarrete-Calvo et al. 2016).

We consider that the increase in the sedation scores of the dexketoprofen trometamol group during the procedure compared to the control and paracetamol groups in our study might be due to the analgesic quality or pharmacokinetic drug-drug interactions that cause relaxation or sleep, as in the study of Hanna et al. (2003).

Kesimci et al. revealed that oral dexketoprofen trometamol 25 mg administered preemptively during the first 24 h following lumbar disc surgery was associated with a reduction of up to 35% in morphine consumption compared to placebo, whereas paracetamol 500 mg did not show the expected opioid-sparing effect comparatively (Kesimci et al. 2011).

In their comparative study of oral 25 mg dexketoprofen trometamol administered perioperatively in elective knee arthroplasty operations with placebo, Lohom et al. found out that the VAS scores at the postoperative 15th hour were lower in the dexketoprofen trometamol group and suggested that dexketoprofen trometamol significantly improved analgesia for 8 h and reduced the need for opioids (Iohom et al. 2002).

In another study by Ozer et al., it was observed that all groups that received dexketoprofen achieved significantly lower tramadol consumption for 24 h after surgery and during recovery room follow-ups, with lower VAS scores compared to the control group. They stated that the effects of intravenously administered dexketoprofen on postoperative analgesia and patient satisfaction in septorhinoplasty operations were favorable; however, no significant difference was found between preoperative and intraoperative practices (Ozer et al. 2012).

Likewise, in our study, similar to the literature, we observed that postoperative VAS values of dexketoprofen trometamol were significantly lower than both paracetamol and tramadol groups, and postoperative additional analgesia needs were significantly lower than both other groups.

Our study has several limitations. The study is a report of our own clinical experience. Data were collected retrospectively from clinical charts, forms, and electronic data designed for clinical purposes.