Page 12 - World Journal of Laparoscopic Surgeons

Kunal Chowdhary et al
was taken before the surgery. All patients underwent Table 3: Postoperative side effects
standard preanesthetic check-up, and intubation was Group I (diclofenac) Group II (tramadol)
done with standard protocol. The same line of manage- Variable (n = 25) (n = 25)
ment was used for all patients pre- and intraoperatively. Nausea/vomiting/ 2 10
sedation
Laparoscopic cholecystectomy was performed with Gastritis 6 2
standard 4-port technique. Insufflation was done with
co and intraperitoneal pressure was maintained at
2
14 mm Hg. Postoperatively 100 mg of tramadol and 75 mg Group I having diclofenac has higher incidence of
of diclofenac were given intravenously according to the gastritis as compared with group II having tramadol
patient group distribution 8 hourly, and patient pain was management (Table 3).
measured on VAS on 6, 12, 18, and 24 hours. Additional
complaint other than pain was managed in both the DISCUSSION
groups. The advent of laparoscopic cholecystectomy was a
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milestone achievement in the treatment of gallstones.
RESULTS
Laparoscopic cholecystectomy is the gold standard treat-
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Totally 50 patients, divided into two groups I and II, were ment for the management of symptomatic gallbladder.
taken in this study from December 2016 to December 2017 Postoperative pain management is an essential compo-
who underwent laparoscopic cholecystectomy. Group I nent in surgical patients; if pain management is not done
7,8
was given injection diclofenac and group II was given effectively, it may lead to increase in morbidity Good
injection tramadol postoperatively for pain management analgesia can decrease morbidity and decrease hospital
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8 hourly. Both I and II groups were matched in all respects stay postoperatively. A similar study conducted by Sinha
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with age, weight, and operative time. Patients ranging et al revealed higher benefit of tramadol over diclofenac
from age 18 to 70 years were taken in this study. The in terms of postoperative pain without any major adverse

average age in group I was 36.2 years and that in group II event. In the early hours of postoperative period, visceral
was 40 years. The average weight in two groups I and II pain is a major cause of pain. Intensity progressively
is respectively, 62.2 and 64.1; 64.2 and 66 minutes is the decreases with postoperative hours if good analgesia
average time taken in both groups I and II respectively is given. Postoperatively, laparoscopic cholecystectomy
(Table 1). Pain relief after diclofenac first dose postopera- visceral pain is not intensified by mobilization as mobi-
tively in 8 hours was seen in 7 patients, in 9 to 16 hours in lization only requires movement of abdominal muscle,
12 patients, and 17 to 24 hours in 18 patients. Pain relief not the visceral movement. On the contrary, cough
after tramadol first dose postoperatively in 8 hours was causes displacement of the liver and viscera resulting in
seen in 16 patients, in 9 to 16 hour in 21 patients, and 17 to movement of operated site of cholecystectomy causing
24 hours in 25 patients (Table 2). Postoperatively, patients pain. The visceral pain is more severe than parietal
complained of nausea, vomiting, and gastritis. Group II pain in laparoscopic cholecystectomy, leading to limited
having tramadol infusion complained of higher incidence damage to the abdominal wall. The study concluded
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of nausea and vomiting as compared with group I having that tramadol is a better management than diclofenac
diclofenac for pain management. for managing pain in postoperatively laparoscopic cho-
lecystectomy. But patients with tramadol management
Table 1: Parameters of patients in groups I and II have higher incidence of side effects (nausea/vomiting).
Group I (diclofenac) Group II (tramadol) Postoperative prophylactic management of opioids is not
Variable (n = 25) (n = 25) usually preferred due to the high rate of side effects.
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Mean age 36.2 40 Gousheh et al conducted a study in which, to overcome
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Mean weight 62.2 64.1
Male/female 12/13 14/11 the side effect of opioids, paracetamol was used in post-
Mean surgical time 64.2 66 operative laparoscopic cholecystectomy period. Opioids
consumption was reduced when paracetamol was used
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and opioids’ side effects were reduced. Brodner et al
Table 2: Pain relief in groups I and II after injectable diclofenac
and tramadol conducted a study on a total of 196 patients. The nono-
pioid analgesics and paracetamol had similar efficacy.
Group I (diclofenac) Group II (tramadol)
Pain relief (n = 25) (n = 25) Surgical pain was reduced with all nonopioids compared
0–8 hourly 7 16 with placebo; there was no effect on associated pain.
9–16 hourly 12 21 Piritramide dosage and incidence of side effects were
17–24 hourly 18 25 not reduced.
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