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10.5005/jp-journals-10033-1260
Can Intraperitoneal Tramadol decrease Pain in Patients undergoing Laparoscopic Cholecystectomy
ORIGINAL ARTICLE

Can Intraperitoneal Tramadol decrease Pain in Patients

undergoing Laparoscopic Cholecystectomy in the
Postoperative Period? A Randomized controlled Trial

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1 Ankush Jairath, Shinu Gupta, Kuldip Singh, Sunil Katyal
ABSTRACT INTRODUCTION
Aim: To evaluate the analgesic effect of intraperitoneal trama- Laparoscopic cholecystectomy has become the treatment
dol in patients undergoing laparoscopic cholecystectomy.
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of choice for gallbladder stone disease as it offers many
Settings and design: Prospective, double blind, randomized advantages compared with the open cholecystectomy,
study
the major advantage being shorter duration of hospi-
Materials and methods: A total of 100 patients undergoing tal stay and early convalescence, but some patients
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laparoscopic cholecystectomy were randomized into two groups
I and II of 50 patients each: Group I received intraperitoneal still experience considerable pain in the postoperative
tramadol 100 mg (diluted in 20 ml of distilled water) immediately period. The site of most severe pain is in the right upper
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after induction of pneumoperitoneum and just before removal of quadrant and port site during first 24 hours, which can
trocars. Similarly, Group II received 20 ml of intraperitoneal normal be due to traumatic traction on the nerves, release of
saline. All patients had a standard anesthetic. Rescue analgesia
was with diclofenac sodium. Postoperatively, visual analog scale inflammatory molecules, trauma to the abdominal wall,
scores, 1 and 24 hours diclofenac consumption, postoperative maintenance of high abdominal pressure, and irritation
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hospital course, and adverse effects were recorded. of the phrenic nerve. While laparotomy results mainly
Statistical analysis used: Student’s t test and Epi Info sta- in parietal pain, laparoscopy has a visceral component,
tistical software. a somatic component, and shoulder pain secondary
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Results: Pain intensity is significantly less in group I than in to diaphragmatic irritation. In laparoscopic cholecys-
group II in the first 4 hours, while requirement of analgesic tectomy, visceral pain predominates in first 24 hours,
postoperatively is significantly less in group I than in group II
in the first 8 hours except at 30 and 60 minutes. Better control whereas shoulder pain, less on the 1st day, increases and
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of blood pressure and respiratory rate was seen in group I in becomes significant on the following days. The degree
the first 4 hours. There was no significant difference between of pain after laparoscopic procedure is influenced by
the two groups regarding postoperative hospital course and factors, such as the volume of residual gas, the type and
incidence of adverse effect.
temperature of gas used for pneumoperitoneum, and
Conclusion: Intraperitoneal tramadol provides superior the pressure created by pneumoperitoneum. The perito-
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postoperative analgesia in the early postoperative period after
laparoscopic cholecystectomy compared with normal saline in neal origin of the pain suggests that analgesia delivered
patients undergoing laparoscopic cholecystectomy. locally to the peritoneal cavity may be of benefit post-
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Keywords: Intraperitoneal tramadol, Laparoscopic cholecys- operatively. While some studies show that intraperito-
tectomy, Pain, Visual analog scale. neal instillation of drugs for pain relief is more effective
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How to cite this article: Jairath A, Gupta S, Singh K, Katyal S. if used before creation of pneumoperitoneum, others
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Can Intraperitoneal Tramadol decrease Pain in Patients undergo- suggest it to be more effective at the end of the surgery.
ing Laparoscopic Cholecystectomy in the Postoperative Period? So, considering these facts, the present study was under-
A Randomized controlled Trial. World J Lap Surg 2016;9(1):5-8. taken to evaluate analgesic effect of intraperitoneal
Source of support: Nil tramadol in patients undergoing laparoscopic cholecys-
Conflict of interest: None tectomy.

MATeRIALS AND MeTHODS
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1,2 Senior Resident, Consultant
After approval from the ethical committee, the study
1,3 Department of Surgery, Dayanand Medical College and
Hospital, Ludhiana, Punjab, India was conducted on 100 patients scheduled for elective
laparoscopic cholecystectomy under a standardized
2,4 Department of Anesthesia, Dayanand Medical College and
Hospital, Ludhiana, Punjab, India general anesthesia technique after informed consent.
Uncooperative and unwilling patients, those with
Corresponding Author: Ankush Jairath, Senior Resident
Department of Surgery, Dayanand Medical College and history of anaphylaxis to opioids, drug abuse, narcotic
Hospital, Ludhiana, Punjab, India, Phone: +919601560089 use or previous abdominal surgery, American Society of
e-mail: ankushjairath@gmail.com Anesthesiologists grade III, IV, V, or any other significant

World Journal of Laparoscopic Surgery, January-April 2016;9(1):5-8 5