Rajesh A. Kamtane1, Shailendra D2, Prasuna G3, Subbaratnam Y4

BACKGROUND: Effective postoperative pain control is an essential component of the care of the surgical patient. Inadequate pain control, apart from being inhumane, may result in increased morbidity or mortality. Opioids have been the mainstay of treatment for post-operative pain but their side effects such as respiratory depression, sedation, constipation, urinary retention, nausea, vomiting, hypotension, bradycardia, and itching limit their use. Tramadol is a semi-synthetic opiate which has the advantage of less respiratory depression (<1%) besides its good analgesic effect. Non-steroidal anti-inflammatory drugs (NSAIDs) have recently gained wide spread popularity in postoperative pain management. Most NSAIDs have been used for treatment of postoperative pain. However, associated side effects include peptic ulcer disease, gastrointestinal hemorrhage, renal dysfunction, altered liver function, and platelet dysfunction.

OBJECTIVE: The objective of this study was to compare the efficacy and safety of Tramadol and Diclofenac in relieving postoperative pain.

MATERIALS AND METHODS: A randomized, open labelled, prospective, comparative clinical study was conducted in 80 post-operative patients, to compare the efficacy and safety of Diclofenac and Tramadol. Diclofenac was prescribed to 40 post-operative patients and Tramadol to another 40 post-operative patients for treatment of pain. Patients were assessed for pain score only once in a day. They were asked to report the average pain intensity over the past 24 hours. Pain was assessed from the time of shifting of the patient to post-operative ward till discharge of the patient from the hospital or number of days the study drugs was given, whichever was earlier.

RESULTS: The mean pain score on post op day 0 in Diclofenac group was 9.25 and that in Tramadol group was 8.97 (P =0.16).The mean pain score on post-operative day 7 in Diclofenac group was 2.50 and that in Tramadol group was 3.00 (P =0.67.5).The overall incidence of adverse effects was 2.5% in Diclofenac group and 7.5% in Tramadol group (p=0.31).

CONCLUSION: Both, Tramadol and Diclofenac were equally effective in reducing post-operative pain. The difference in requirement of rescue analgesia and incidence of adverse effects was statistically insignificant in both the groups.