Compare the analgesic efficacy of intravenous versus wound instillation of Tramadol for postoperative analgesia

Background and Aim: Effective postoperative analgesia improves early mobilization, patient’s satisfaction and reduces psychological stress. Now a days wound instillation of local anaesthetic is commonly used method to provide post-operative analgesia. We design this study to compare the post-operative analgesic effect of tramadol when administered intravenously or in wound instillation with bupivacaine. Materials and Methods: In this study, 100 patients posted for elective abdominal surgeries under general anaesthesia were randomly divided into two groups (n=50) and were given the following drugs after surgery as per group allocation: Group A patients received 2mg/kg tramadol intravenously plus wound instillation with 15 ml 0.5% bupivacaine and Group B received 2mg/kg tramadol with 15 ml 0.5% bupivacaine in wound instillation. Rescue analgesia was provided by intravenous morphine 0.05mg/kg. Verbal Numerical Rating Scale (VNRS) on movement was assessed at 0, 1, 3, 6, 8, 12 and 24 h following surgery. Patients were also observed for post-operative 24 hrs rescue analgesic requirement, patients satisfaction score and any adverse effects. Results: VNRS on movement was significantly reduced at 1 and 3 h after surgery in Group B as compared to Group A (P=0.001). Analgesic efficacy was similar in both the groups at all time intervals. The satisfaction scores at 12 and 24 h post-operatively were superior in group B as compared to group A (P <0.05). Patients receiving IV tramadol had more vomiting and sedation. Conclusions: Analgesic efficacy of wound instillation with tramadol was comparable to intravenous tramadol after lower abdominal surgeries along with better satisfactory scores and lessor side effects.