To evaluate the analgesic efficacy of intraperitoneal tramadol vs. Placebo for postoperative pain relief following laparoscopic appendicectomy – a double blinded one year randomized control trial: single centric, hospital based study

Abstract

Background and Objectives Early postoperative pain is common and predominant complaint which results in prolonged hospital stay. The present study explores effectiveness of intraperitoneal instillation of tramadol on postoperative pain relief and emergence of adverse effects following laparoscopic appendectomy. Methodology The present one year double blinded randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2014 to December 2014. A total of 60 patients undergoing elective laparoscopic appendectomy were enrolled. The selected patients were divided into two groups of 30 each as group A and B based on the drugs that is intraperitoneal tramadol 150 mg (diluted in 40 ml of normal saline) and 40 ml of intraperitoneal normal saline respectively. Results In group A, 53.33% of the patients were males compared and 46.67% in group B (p=0.606). The mean age in group A (26.13±9.96years) and group B (31.43±14.81years) were comparable (p=0.110). Both the groups were comparable in terms of demographic characteristics, clinical presentation and vitals (p>0.050) The mean VAS scores at beginning were significantly low in group A (1.53±0.94) compared to group B (2.93±1.17) and similar trend was noted at all the durations through the post operative period (p<0.001). Most of the patients in group A did not request for the post operative analgesia (56.67% vs 6.67%; p=0.011). In group A, significantly lower numbers of mean doses were administered (0.57±0.82 vs 2.20±0.92; p<0.001). The frequency of postoperative rescue analgesia significantly low in group A at 15 minutes, 30 minutes, 6 hours and 12 hours as compared to group B (p<0.050). Adverse events were noted in 23.33% of the patients with group A compared to 10% in group B (p=0.166). The mean hospital stay in group A was significantly low (p=0.017). Conclusion and interpretation Intraperitoneal instillation of tramadol offers effective postoperative visceral pain relief in laparoscopic appendectomy and incidence of adverse effects is well acceptable.