Background and Objectives: Preemptive analgesia involves administering analgesics before surgical trauma to prevent central sensitization and improve postoperative pain management. Diclofenac sodium, a widely used non-steroidal anti-inflammatory drug (NSAID), is available in multiple formulations, including intramuscular (IM) injection and transdermal patches. This study compares the efficacy and safety of transdermal diclofenac patches versus IM diclofenac injection as preemptive analgesia in patients undergoing perianal and perineum surgeries under saddle block anesthesia. Methods: A prospective observational study was conducted at a tertiary care teaching hospital over 1.5 years. A total of 98 patients (49 in each group) aged 18–60 years, ASA Grade I-III, undergoing perianal and perineum surgeries, were randomly assigned to receive either a transdermal diclofenac patch (GT group) or IM diclofenac injection (GD group) before surgery. Baseline parameters, intraoperative hemodynamics, time to achieve sensory block, and postoperative Visual Analog Scale (VAS) scores were recorded and analyzed using appropriate statistical methods. Results: Demographic characteristics were comparable between both groups. The mean onset of duration of analgesia was significantly longer in the transdermal diclofenac patch group (7.26±1.6 hours) compared to the IM diclofenac injection group (6.38±1.0 hours) (p<0.05). Postoperative VAS scores indicated that pain relief lasted longer in the GT group, with a significantly lower pain perception up to 24 hours postoperatively. No significant differences in intraoperative hemodynamics were observed between the two groups (p>0.05). The transdermal patch provided a painless, non-invasive alternative with better patient compliance and prolonged analgesic effect compared to IM diclofenac. Conclusion: Transdermal diclofenac patches offer an effective and non-invasive alternative to IM diclofenac injection as preemptive analgesia in perianal and perineum surgeries under saddle block. The prolonged analgesic duration and improved patient comfort make transdermal patches a viable option for postoperative pain management.

Preemptive analgesia, Transdermal diclofenac patch, Intramuscular diclofenac injection, Saddle block, Perianal surgery, Perineum surgery, Postoperative pain management