Page 30 - World Journal of Laparoscopic Surgery

Ankush Jairath et al

Graph 2: Cumulative requirement of analgesic Graph 3: Trends in incidence of adverse effects

Table 2: Trends in systolic BP Table 3: Trends in RR
Time Group I Group II Time Group I Group II
(hours) Mean SD Mean SD p-value (hours) Mean SD Mean SD p-value
0 131.44 16.54 146.08 18.02 0.0001 0 21.56 1.42 22.88 1.35 0.0001
4 125.00 11.86 132.16 11.84 0.003 4 20.88 1.15 21.84 1.06 0.0001
8 124.44 10.93 124.52 10.03 0.970 8 21.12 1.67 21.64 1.05 0.065
16 121.48 9.96 125.24 11.71 0.087 16 20.48 1.49 20.56 1.28 0.774
24 122.44 8.83 124.28 11.49 0.371 24 20.24 1.70 20.32 1.58 0.808
SD: Standard deviation SD: Standard deviation

The supplementary mean dose of rescue analgesic maximum mean VAS score was observed at 8th hour
(diclofenac sodium, 3 mL, 75 mg) in first hour and (2.32 ± 0.96 cm). Administration of rescue analgesic there-
24 hours were significantly higher in group II, being after leads to downward trend in subsequent pain scores.
14
76.47 ± 10.39 mg and 213 ± 41.11 mg as compared to The results are consistent with findings of Golubovic et al

group I of 0 and 84 ± 59.92 mg respectively (Graph 2). who showed this significant reduction for first 6 hours.
There is no significant difference between mean HR, Our study also showed significant reduction in cumu-
SPO , temperature between the two groups at any point lative postoperative analgesic requirement in group I than
2
of time during our study. Mean systolic BP (Table 2) and in group II in first and 24 hours, which is consistent with
RR (Table 3) were lower in group I than in group II at all study done by Golubovic et al, 14,15 who demonstrated that
time intervals, but the difference is significant statistically intraperitoneal administration of tramadol had valu-
at 0 and 4 hours attributed to better pain control in early able implication in reducing VAS score/pain in patients
postoperative period. undergoing laparoscopic cholecystectomy.
There was no significant difference in the incidence Peripheral antinociceptive effect of opioids occurs
of shoulder pain, nausea, vomiting sedation, itching, due to interaction of opioids with opioid receptor located
and shivering in the two groups (Graph 3). No patient on peripheral intact perineurium that prevent entry of
experienced muscle rigidity. hydrophilic opioid molecule, such as morphine while
lipophilic opioids, such as tramadol, buprenorphine can
diffuse across the intact perineural barrier, which results
DISCUSSION
in better analgesia on intraperitoneal administration.
In our study we showed that intraperitoneal admin- Secondly, as duration of action of parenterally admin-
istration of tramadol resulted in much lower postop- istered tramadol is 6 to 8 hours, so this explains low
erative pain scores, cumulative postoperative analgesic VAS scores and less need for rescue analgesic in early
consumption without significant increase in incidence postoperative period. 16
of adverse effect or adverse hemodynamic changes in Mean systolic BP and RR were lower in group I
patients undergoing laparoscopic cholecystectomy. than in group II at all time intervals but the difference
In our study, the mean VAS scores in group I were signif- is significant statistically at 0 and 4 hours attributed to
icantly low in first 4 hours postoperatively than in group II better pain control in early postoperative period. As there

due to the effect of Tramadol given intraperitoneally. The was no differences in the incidence of adverse effect, so
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