Preemptive Intravenous Paracetamol with or without Tramadol for Postoperative Pain After Elective Abdominal Surgery: a retrospective study

Abstract

Introduction and aim: Prevention or reduction of postoperative (PO) pain is still a challenge, as it had a different drawbacks on  the healing process and patient quality of life. The current study aimed to evaluate the value of preemptive paracetamol with or without tramadol in management of postoperative pain control after abdominal surgery.

Methodology: This is a retrospective study of 90 patients who submitted to elective abdominal surgery. Patients were classified into three equal groups. The first for paracetamol, the second for paracetamol-tramadol and the third for placebo (saline). One hour before surgery a dose of paracetamol (1 gm diluted in 100 ml saline) was administered for the first two groups, in addition to 100 mg of intravenous tramadol to the second group. The primary outcome was PO pain in the first 24 hours after surgery. The secondary outcomes include time for the first analgesic request and cumulative dose of analgesia. Also, nausea and vomiting were documented.  

Results: The group of paracetamol-tramadol was associated with significant lower VAS score at 4, 6, 8, 10 and 12 hours postoperatively than paracetamol alone or saline groups. Time to the first analgesic request was significantly longer in paracetamol-tramadol (138.00±24.41 minutes) than paracetamol alone (100.0±31.84 minutes) or saline group (82.33±23.73 minutes). The total cumulative analgesia in the first PO Day was significantly lower in paracetamol-tramadol (158.33±79.96 mg) than paracetamol (245.00±73.52 mg) or saline group (276.67±75.12 mg). Nausea and vomiting were reported in 9, 8 and 10 in paracetamol, paracetamol-tramadol and saline groups respectively with no significant differences.

Conclusion: The use of preemptive paracetamol alone or combined with tramadol is an effective intervention to reduce the postoperative pain after abdominal surgery. It reduces the use of postoperative analgesics with subsequent effect on the cost and healthcare system.