To Evaluate The Analgesic Efficacy Of Intraperitoneal Instillation Of Tramadol Versus Bupivacaine For Post Operative Pain Relief Following Laparoscopic Appendectomy, A Double Blind Randomized Control Trial, Hospital Based Study

Abstract

Background and Objectives Early postoperative pain is the most prevalent and dominant complaint after elective laparoscopic surgeries. This study was aimed to compare the effectiveness of intraperitoneal instillation of tramadol versus bupivacaine for postoperative pain relief after laparoscopic appendectomy especially visceral and shoulder tip pain and to evaluate adverse effect such as nausea, vomiting, shoulder pain and shivering following laparoscopic appendectomy. Methodology This one year double blinded randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2015 to December 2015. A total of 60 patients posted for elective laparoscopic appendectomy were studied. Based on computer generated random numbers, these patients were divided into two groups of 30 each as group A (intraperitoneal instillation of tramadol 150 mg) and Group B (intraperitoneal instillation of 0.5% bupivacaine). Results In the present study, most of the patients were females that is 53.33% and 60% in Group A and Group B respectively (p=0.602). The mean age in group A and group B was comparable (37.03 ± 1.00 vs 37.13 ± 0.73 years; p=0.660) The Mean pain scores at 4, 8, 16 and 24 in group A were significantly low compared to group B (p<0.050). At 24 hours interval significantly higher number of patients in group B (90%) required rescue analgesia compared to group A (46.67%) (p<0.001). The overall requirement of analgesia was significantly high in patients with Group B that is, 10% of the patients did not required while 36.67% required 75 mg, and 150 mg each, 10% required 225 mg and 6.67% required 300 mg compared to 53.33%, 20%, 23.33%, 3.33% and 0% in group A. (p=0.007) The requirement of mean analgesia was significantly high in group B, (125.00 ±77.12 mg) compared to group A (57.50 ± 70.14 mg) (p<0.001). Overall incidence of adverse effects was comparable in group A and group B (76.67% vs 920%; p=0.166). At 16 hours, incidence of vomiting was significantly high in group A (23.33%) compared to nil in group B while in group B shoulder tip pain was noted among 10% of the patients while it was not reported by any of the patient in group A (p=0.003). Conclusion and interpretation Intraperitoneal instillation of tramadol offers excellent pain relief. However, its safety profile is comparable to that of intraperitoneal instillation with of 0.5% bupivacaine.