COMPARATIVE STUDY OF TRAMADOL SUPPOSITORY VERSUS IV TRAMADOL IN PATIENTS UNDERGOING CESAREAN SECTION SURGERY: POST OPERATIVE PAIN RELIEF

Abstract

Background

Effective pain management during the perioperative period is crucial for optimizing patient outcomes following surgery. Proper pain relief not only facilitates early mobilization but also contributes to quicker discharge. In the early postoperative phase, oral medications are typically not an option, making injectable analgesics the standard approach for pain management.

Material and Methods

We assessed 60 patients, with 30 participants in each group. All the participants were classified as ASA II, aged between 18 and 50 years, and underwent cesarean sections under spinal anesthesia. Following the surgery and post-vaginal toileting, Group A received 100 mg of tramadol intravenously, while Group B received 100 mg of tramadol suppository rectally. Intraoperative and perioperative vital signs were recorded, and side effects such as nausea, vomiting, and pruritus were monitored. If at any point the visual analog scale (VAS) score reached 6 or higher, an intravenous injection of paracetamol (15 mg/kg) was administered, and the study was concluded. The timing of the rescue analgesic administration was recorded, and patients were monitored postoperatively at 6, 12, and 24 hours. The total number of rescue analgesics administered within the 24-hour postoperative period was also documented.

Results

In our study, the tramadol suppository group showed mean VAS scores was 0, 2.6 ± 0.67, 3.03 ± 0.71, 4.53 ± 0.77, at 0, 6, 12, and 24 hours respectively and the IV tramadol group had mean VAS score was 0, 3.47 ± 0.50,3.97 ± 0.8, 4.87 ± 0.81 at 0, 6, 12 and 24 hours respectively. The mean Visual Analogue Scale (VAS) score was significantly lower in the suppository group compared to the IV tramadol group. In the suppository group, out of 50 patients, 4 (8%) required rescue analgesia at 6 hours, 8 (16%) at 12 hours, and 12 (24%) at 24 hours postoperatively. In contrast, in the IV tramadol group, 16 patients (32%) needed rescue analgesia at 6 hours, 20 (40%) at 12 hours, and 20 (40%) at 24 hours postoperatively.

Conclusions

The suppository group experienced prolonged analgesia and required fewer rescue analgesics compared to the IV group. Additionally, nausea and vomiting were less frequent in the suppository group. Rectal tramadol provides more effective postoperative pain relief after cesarean section than intravenous tramadol, offering longer-lasting pain control and fewer side effects.