Comparison of diclofenac suppository with tramadol suppository for post operative analgesia in abdominal hysterectomy patients
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 5
Abstract
Background: Post-op pain management is these days considered as the fifth vital sign in addition to temperature, pulse, respiratory rate, blood pressure. Various drugs are used to control the post op pain namely NSAID’s, opiods, ketamine, continuous regional blocks, etc. Also these drugs can be used by various routes mainly intravenous, intramuscular ,oral ,cutaneous patch and rectal route(suppository). Suppository has advantage that it decreases nausea, vomiting, gastritis, has no pain on administration, has predictable absorption and can be used in NBM patients Aim and Objective: To study and compare the effects of Diclofenac and tramadol suppository when used as preemptive analgesia in abdominal hysterectomy patients and also to compare the side effects of the same. Material and Method: Written informed consent was obtained from all the patients(30 patients each of tramadol and diclofenac group were selected). Patients were explained about pain assessment process by using VAS score. They were given sub arachnoid block with injection bupivacaine ( hyperbaric(0.5%) ) 3.4 cc at L3-L4 level using 25G needle in left lateral position to achieve appropriate level of anesthesia. After giving subarachnoid block and the patient made supine, rectal suppository was inserted. Using block randomization method, the patients were randomly divided into either of two groups 1) Group T: patients receiving Tramadol 100 mg rectal suppository 2) Group D : patients receiving Diclofenac 100 mg rectal suppository 3) Intra-operatively patient were given midazolam 1 mg IV and fortwin 15 mg IV. Assessment of pain was done using Visual Analogue Scale (VAS) by an observer, that will be graded ruler ranging from 0-10 showing the minimal and maximum pain score respectively. The score was assessed post operatively in post-op recovery room at 1,2,4,6 and 12 hours . If VAS is > 3 upto 12 hours then inj. Paracetamol was given as rescue analgesia. Side effects was recorded in the form of nausea, vomiting, respiratory depression. The results was then statistically analysed. Observation and Results: Mean duration of analgesia is statistically highly significant in Group D.( D < 0.05).We have found the significant outcome ( p < 0.05 at 4 and 6 hr postoperatively) in VAS pain score in between the two groups at different intervals. Patients who were administered Diclofenac suppository had shown low VAS score with less requirement of rescue analgesia and side effects. Conclusion: Diclofenac suppository is safer and more effective compared to tramadol suppository when used preemptively for the treatment of postoperative pain after spinal anesthesia in hysterectomy patients.
Authors and Affiliations
Sagar Sahil, Manohar Mane, Jyotsana Paranjape
Keywords
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