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WJOLS

Ankush Jairath et al 10.5005/jp-journals-10033-1297
OriginaL articLe

Can Intraperitoneal Tramadol decrease Pain in Patients

undergoing Laparoscopic Cholecystectomy in Postoperative
Period? A Randomized Controlled Trial

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1 Ankush Jairath, Shinu Gupta, Kuldip Singh, Sunil Katyal
3
2
ABSTRACT Source of support: Nil
Aim: To evaluate analgesic effect of intraperitoneal tramadol Conflict of interest: None
in patients undergoing laparoscopic cholecystectomy.

Settings and design: Prospective, double blind, randomized INTRODUCTION
study.
Laparoscopic cholecystectomy has become the treatment
Materials and methods: Hundred patients undergoing laparo- 1
scopic cholecystectomy were randomized into two groups, I and of choice for gallbladder stone disease as it offers many
II, of 50 each: Group I received intraperitoneal tramadol 100 mg advantages compared with the open cholecystectomy,
(diluted in 20 mL of distilled water) immediately after induction the major being shorter duration of hospital stay and
of pneumoperitoneum and just before removal of trocars. Simi- early convalescence, but some patients still experience
2
larly, group II received 20 mL of intraperitoneal normal saline. considerable pain in postoperative period. The site of
All patients had a standard anesthetic. Rescue analgesia was
with diclofenac sodium. Postoperatively, visual analog scale, most severe pain is in the right upper quadrant and port
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1 and 24 hours diclofenac consumption, postoperative hospital site during first 24 hours, which can be due to traumatic
course, and adverse effects were recorded. traction on the nerves; release of inflammatory mol-
Statistical analysis: Student’s t-test and Epi Info statistical ecules; trauma to the abdominal wall; maintenance of
software were used for statistical analysis. high abdominal pressure; and irritation of the phrenic
4,5
Results: Pain intensity is significantly less in group I than nerve. While laparotomy results mainly in parietal
in group II in first 4 hours, while requirement of analgesic pain, laparoscopy has a visceral component, a somatic

postoperatively is significantly less in group I than in group II component and shoulder pain secondary to diaphrag-
in first 8 hours except at 30 and 60 minutes. Better control matic irritation. In laparoscopic cholecystectomy, visceral
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of blood pressure and respiratory rate was seen in group I in
first 4 hours. There was no significant difference between two pain predominates in first 24 hours, whereas shoulder
groups regarding postoperative hospital course and incidence pain, less on the 1st day, increases and becomes sig-
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of adverse effect. nificant on the following days. The degree of pain after
Conclusion: Intraperitoneally, tramadol provides superior laparoscopic procedure is influenced by factors, such as
postoperative analgesia in the early postoperative period after the volume of residual gas, the type, temperature of gas
laparoscopic cholecystectomy compared with normal saline in used for pneumoperitoneum, and the pressure created
patients undergoing laparoscopic cholecystectomy. by pneumoperitoneum. The peritoneal origin of the pain
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Keywords: Intraperitoneal tramadol, Laparoscopic cholecys- suggests that analgesia delivered locally to the peritoneal
tectomy, Pain, Visual analog scale score. cavity may be of benefit postoperatively. While some
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How to cite this article: Jairath A, Gupta S, Singh K, Katyal S. studies show that intraperitoneal instillation of drugs

Can Intraperitoneal Tramadol decrease Pain in Patients for pain relief is more effective if used before creation of
undergoing Laparoscopic Cholecystectomy in Postoperative pneumoperitoneum, others suggest it to be more effec-
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Period? A Randomized Controlled Trial. World J Lap Surg tive at the end of the surgery. So, considering these facts
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2017;10(1):26-29.
the present study was undertaken to evaluate analgesic
effect of intraperitoneal tramadol in patients undergoing
3,4
1,2 Senior Resident, Consultant laparoscopic cholecystectomy.
1,3 Department of Surgery, Dayanand Medical College and
Hospital, Ludhiana, Punjab, India MATERIALS AND METHODS
2,4 Department of Anesthesia, Dayanand Medical College and After approval from Ethical Committee, the study was
Hospital, Ludhiana, Punjab, India conducted on 100 patients scheduled for elective lapa-
Corresponding Author: Ankush Jairath, Senior Resident roscopic cholecystectomy under a standardized general
Department of Surgery, Dayanand Medical College and anesthesia technique after informed consent. Uncoopera-
Hospital, Ludhiana, Punjab, India, Phone: +919601560089 tive and unwilling patients; those with a history of ana-
e-mail: ankushjairath@gmail.com
phylaxis to opioids, drug abuse, narcotic use, or previous
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