Page 11 - World Journal of Laparoscopic Surgeons

WJOLS
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10.5005/jp-journals-10007-1325
Injectable Tramadol vs Diclofenac for Postoperative Pain Management
ORIGINAL ARTICLE

Injectable Tramadol vs Diclofenac for Postoperative Pain

Management in Laparoscopic Cholecystectomy Surgery:
A Comparative Prospective Study

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1 Kunal Chowdhary, Muzzafar Zaman, Rahul Yadav, Ashish K Choudhary, Preeti Grewal, Ashutosh Bawa, Aliya Shah
ABSTRACT a better option than diclofenac for pain relief and comfortable
postoperative period.
Introduction: Laparoscopic management of gallstones is
considered as the gold standard treatment nowadays and is Keywords: Diclofenac, Laparoscopic cholecystectomy, Pain,
the most common surgery done in the present scenario. Post- Tramadol.
operative pain remains one of the most common complaints How to cite this article: Chowdhary K, Zaman M, Yadav R,
after laparoscopic cholecystectomy and should be managed
with proper analgesia with minimal side effects. Choudhary AK, Grewal P, Bawa A, Shah A. Injectable Tramadol
vs Diclofenac for Postoperative Pain Management in Laparo-
Aim: To compare the efficacy of injectable tramadol and scopic Cholecystectomy Surgery: A Comparative Prospective
diclofenac in the pain management after laparoscopic chole- Study. World J Lap Surg 2018;11(1):5-7.
cystectomy surgery.
Source of support: Nil
Materials and methods: A randomized prospective study
was done at Maharishi Markandeshwar College of Medical Conflict of interest: None
Science & Research in the Department of General Surgery
on 50 patients undergoing laparoscopic surgery between INTRODUCTION
December 2016 and December 2017. Postoperative analgesic
is decided randomly with the help of dice. Pain is measured on Laparoscopic cholecystectomy is the most common
visual analog scale (VAS) on 6, 12, 18, and 24 hours. minimal access procedure performed by surgeon nowa-
Results: A total of 50 patients, divided in two groups I and II, days. Laparoscopic cholecystectomy is considered as
were taken in this study from December 2016 to December the gold standard and treatment of choice for gallstone
2017 who underwent laparoscopic cholecystectomy. Group I disease. In the postoperative period, pain is the most
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was given injection diclofenac and group II was given injection
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tramadol postoperatively for pain management 8 hourly. Both common complaint seen. For the management of pain,
I and II groups were matched in all respect with age, weight, various medications are used. Diclofenac is a nonsteroidal
and operative time. Pain relief after diclofenac first dose post- anti-inflammatory drug of phenyl acetic acid class having
operatively in 8 hours was seen in 7 patients, in 9 to 16 hours antipyretic, anti-inflammatory, analgesic effects. Diclofenac
in 12 patients, and 17 to 24 hours in 18 patients. Pain relief
after tramadol first dose postoperatively in 8 hours was seen in has greater property to inhibit cyclooxygenase (COX)2
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16 patients, in 9 to 16 hours in 21 patients, and 17 to 24 hours enzyme than COX1. Tramadol acts by inhibition of neu-
in 25 patients. Postoperatively, patients complained of nausea ronal uptake of norepinephrine and serotonin at synapses
and vomiting. Group II having tramadol infusion complained in the descending inhibitory pain pathways. Tramadol is
of higher incidence of nausea and vomiting as compared with 4
group I having diclofenac for pain management. derived as a synthetic analog from codeine. This study is
done to compare the efficacy of tramadol and diclofenac
Conclusion: Pain after laparoscopic cholecystectomy is a
common complaint encountered. Good analgesia should be in the pain management in laparoscopic cholecystectomy.
given to patients but should have minimal side effects. It was
concluded from our study that tramadol in injectable form is MATERIALS AND METHODS
A randomized prospective study was done at Maharishi
Markandeshwar College of Medical Science & Research
1,2 Assistant Professor, 3-7 Postgraduate Student
in the Department of General Surgery on 50 patients
1-6 Department of General Surgery, Maharishi Markandeshwar
Institute of Medical Sciences & Research, Ambala, Haryana undergoing laparoscopic cholecystectomy. Patients were
India divided into two groups randomly, I and II. Each group
contained 25 patients; group I was given diclofenac and
7 Department of Microbiology, Maharishi Markandeshwar Institute
of Medical Sciences & Research, Ambala, Haryana, India group II was given tramadol postoperatively for pain
management 8 hourly. Patients were selected randomly
Corresponding Author: Muzzafar Zaman, Assistant Professor
Department of General Surgery, Maharishi Markandeshwar with the help of dice for the type of analgesia selection.
Institute of Medical Sciences & Research, Ambala, Haryana Patients having drug reaction history with tramadol and
India, Phone: +918059931554, e-mail: muzzafarzaman@yahoo. diclofenac were excluded. Patients were explained about
com
the procedure, VAS score, and written informed consent
World Journal of Laparoscopic Surgery, January-April 2018;11(1):5-7 5