Comparison Of Diclofenac Suppository with Injection Tramadol In Postoperative Pain: Diclofenac Suppository with Injection Tramadol in Postoperative Pain

Abdul  Rab; Sughra  Parveen; Asif  Ali; Ali  Nawaz; Shahzore  Gul; Muhammad  Musadaq

doi:10.54393/pbmj.v5i6.591

Authors

Abdul Rab Jinnah Postgraduate Medical Center, Karachi
Sughra Parveen Jinnah Postgraduate Medical Center, Karachi
Asif Ali Jinnah Postgraduate Medical Center, Karachi
Ali Nawaz Jinnah Postgraduate Medical Center, Karachi
Shahzore Gul Jinnah Postgraduate Medical Center, Karachi
Muhammad Musadaq Jinnah Postgraduate Medical Center, Karachi

DOI:

https://doi.org/10.54393/pbmj.v5i6.591

Keywords:

Abdominal Surgery, Post-Operative Pain, Diclofenac Suppository, Injection Tramadol, and Analgesic Efficacy

Abstract

Pain and damage to tissue structure is frequently observed after surgical procedures. Management of postoperative pain has always been remained a challenge to surgeons because of its detrimental effect on patient’s satisfaction, early mobilization and regaining of functionality. Objective: To compare the analgesic efficacy of diclofenac suppository with injection tramadol 100 mg for postoperative pain relief after abdominal surgeries. Methods: This Randomized Double-Blind Controlled Trial was conducted upon a sample of 98 patients, aged 12 to 60 years and undergoing abdominal surgery (elective and emergency) divided into two groups (Group A: Diclofenac Suppositories 100 mg, and Group B: Injection Tramadol 100 mg), of 49 patients each. Visual Analogue Scale (VAS) was used for measuring the severity of pain at 0, 1, 6, 12, 18 and 24 hours, following surgeries. Results: The mean age of the sample stood at 31 (SD ± 03) years, with most of the sample comprising of males (72.45%). Postoperative pain was experienced by patients in both groups, with group A reporting less severe pain than group B but no statistical difference was found between the severity. Conclusion: After careful consideration, it may be concluded that both agents, namely Diclofenac Suppositories 100 mg, and Injection Tramadol 100 mg are efficacious at managing the postoperative pain hence both may be used interchangeably or in conjunction among patients undergoing abdominal surgeries.

References

Pereira S, Portela F, Santos MF, Machado J, Abelha A. Predicting type of delivery by identification of obstetric risk factors through data mining. Procedia Computer Science. 2015 Jan 1;64:601-9.doi.org/10.1016/j.procs.2015.08.573

Verstraete S, Van de Velde M. Post-cesarean section analgesia. Acta Anaesthesiologica Belgica 2012;63(4):147-67.

Harper CM, Lyles YM. Physiology and complications of bed rest. Journal of the American Geriatrics Society 1988 Nov;36(11):1047-54. doi: 10.1111/j.1532-5415. 1988.tb04375. x.

Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesthesia and analgesia. 1993 Nov;77(5):1048-56. doi: 10.1213/00000539-199311000-00030.

Chan A, Dore CJ, Ramachandra V. Analgesia for day surgery: Evaluation of the effect of diclofenac given before or after surgery with or without bupivacaine infiltration. Anaesthesia. 1996 Jun;51(6):592-5.DOI: 10.1111/j.1365-2044.1996.tb12574.x

Munishankar B, Fettes P, Moore C, McLeod GA. A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. International journal of obstetric anesthesia 2008 Jan;17(1):9-14. doi: 10.1016/j.ijoa.2007.06.006.

Booth JL, Harris LC, Eisenach JC, Pan PH. A Randomized Controlled Trial Comparing Two Multimodal Analgesic Techniques in Patients Predicted to Have Severe Pain After Cesarean Delivery. Anesthesia and analgesia.2016 Apr;122(4):1114-9. doi: 10.1213/ANE.0000000000000695.

Merrikhihaghi S, Farshchi A, Farshchi B, Farshchi S, Abedin-Dorkoosh F. Tramadol versus diclofenac in pain management after cesarean section: A cost analysis study. Journal of Pharmacoeconomics and Pharmaceutical Management. 2015 Oct 5;1(1/2):22-4.

Darvish H, Memar Ardestani B, Mohammadkhani Shali S, Tajik A. Analgesic Efficacy of Diclofenac and Paracetamol vs. Meperidine in Cesarean Section. Anesthesia and Pain Medicine 2013 Dec 26;4(1): e9997. doi: 10.5812/aapm.9997.

Taneja A, Kaur T, Sood IV. Comparative Study on The Effect of Paracetamol, Diclofenac and their Combination in Post-Operative Pain Relief of Cesarean Section. JK Science. 2015;17(1):30.

Nikooseresht M, Seifrabiei MA, Davoodi M, Aghajanlou M, Sardari MT. Diclofenac suppository vs. IV acetaminophen combined with IV PCA for postoperative pain management in patients undergoing laminectomy: a randomized, double-blinded clinical trial. Anesthesiology and pain medicine. 2016 Jun;6(3). DOI: 10.5812/aapm.36812

Hooda R, Pathak P, Chavhan R. Comparative study of diclofenac suppository with tramadol suppository in addition to acetaminophen for post caesarian analgesia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020 Apr 1;9(4):1372-7. doi.org/10.18203/2320-1770.ijrcog20201086

Joshi Vyankatesh S, Vyavahare Ramesh D, Khade Ganesh DS, Jamadar NP. Comparative study of analgesic efficacy of rectal suppository of tramadol versus diclofenac in suppressing postoperative pain after Cesarean section. International journal of biomedical research 2013 Jan;1(2):32-7.

Sahil S, Mane M, Paranjap J. Comparison of diclofenac suppository with tramadol suppositery for post-operative analgesia in abdominal hysterectomy patient. Medpulse International Journal of Medicine 2017;4(5):606-9.

Smith CA, Ruth-Sahd L. Reducing the incidence of postoperative nausea and vomiting begins with risk screening: An evaluation of the evidence. Journal of PeriAnesthesia Nursing. 2016 Apr 1;31(2):158-71. DOI: 10.1016/j.jopan.2015.03.011

Atashkhoei S, Bilehjani E, Fakhari S, Hanieh FA. Postoperative Nausea and Vomiting Prophylaxis with Ondansetron in Diagnostic Gynecologic Laparoscopy: Preemptive versus Preventive Method. Advances in Reproductive Sciences. 2017 Jan 13;5(1):1-9. DOI: 10.4236/arsci.2017.51001

Awad K, Ahmed H, Abushouk AI, et al. Dexamethasone combined with other antiemetics versus single antiemetics for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: An updated systematic review and meta-analysis. International journal of surgery. 2016 Dec 1; 36:152-63. DOI: 10.1016/j.ijsu.2016.10.034

Firdaus K, Dan A, Maaya M, Rahman RA, Kamaruzaman E, Manap NA, et al. Dexamethasone 8 mg Versus Dexamethasone 4 mg with Propofol 0.5 mg/kg for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Gynaecology Procedure. International Medical Journal. 2016 Feb 1;23(1).

Munishankar B, Fettes P, Moore C, McLeod GA. A double-blind randomised controlled trial of paracetamol, diclofenac or the combination for pain relief after caesarean section. International journal of obstetric anesthesia 2008 Jan;17(1):9-14. doi: 10.1016/j.ijoa.2007.06.006.

Chan A, Dore CJ, Ramachandra V. Analgesia for day surgery: Evaluation of the effect of diclofenac given before or after surgery with or without bupivacaine infiltration. Anaesthesia. 1996 Jun;51(6):592-5.DOI: 10.1111/j.1365-2044.1996.tb12574.x

Krzyzanowski SA, Kim K, Smith DC, Young M, Buffington CK. The Effects of a Dexamethasone-based Prophylaxis Protocol on Postoperative Nausea and Vomiting (PONV) and the Duration and Associated Cost of the Hospital Stay. Surgery for Obesity and Related Diseases. 2018 Nov 1;14(11): S7.doi.org/10.1016/j.soard.2018.09.474

Gao C, Li B, Xu L, Lv F, Cao G, Wang H, et al. Efficacy and safety of ramosetron versus ondansetron for postoperative nausea and vomiting after general anesthesia: a meta-analysis of randomized clinical trials. Drug Design Development Therapy. 2015 Apr 23; 9:2343-50. doi: 10.2147/DDDT.S80407.