Aim To demonstrate the analgesic effect of preemptively administered tramadol and metamizole on the postoperative pain severity, after an elective operative hysterectomy with adnexectomy. Methods There were three groups with 30 patients in each group. Patients included in the study were between 45 to 67 years old. They were all in the ASA group II. Randomization was performed in random order according to the regular elective operating program. Patients in Group I received i. m. tramadol 1mg/kg, and in Group II 30mg/kg of metamizole, five minutes before anaesthesia induction. Patients did not receive preemptive analgesia in Group III (control). All patients underwent the same induction anaesthesiology procedure with propofol, fentanyl, tracrium, supplemented with O2, N2O, and sevoflurane at an appropriate dose until MAC 1 was reached. Surgeries lasted for 80-120 minutes. Every patient performed a resting pain assessment 30 minutes after an extubation by Numerical Pain Scale (NPS). Results We found out that tramadol had a better effect in preemptive analgesia and that the average pain score for Group I was 6.10 (p=0.043). In Group II, it was 7.93 (p=0.022). There is significant difference in pain intensity between patients in the control group, (pain intensity was 9.16), and those who received tramadol and metamizole. There was no significant difference in the intensity of pain when using these two analgesics (p=0.733). Conclusion The effect of preemptively administered tramadol prior to the introduction of general anaesthesia in postoperative pain is significantly more favourable than the effect of metamizole.
Agrawal A, Panditrao M, Joshi S. To compare intravenous paracetamol with tramadol given pre-emptively for intraoperative and postoperative analgesia-a randomized controlled trial. Indian Journal of Clinical Anaesthesia 2018:9–12.
2
Del M, Santo, Auge M, R, Ferra A, C. Preemptive analgesia of metamizole versus ibuprofen in retinal laser photocoagulation. Rev Bras Oftalmol 2016:14–7.
3
Oriol-López P-AJ, Hernández-Bernal S, C, Arredondo C, J. Ketorolac vs metamizol preemptive analgesia in children. Cir Cir 2003:50–4.
4
Lu J, Zhang X, Liu C. Effect of preemptive analgesia with flurbiprofen axetil on patient-controlled intravenous analgesia with tramadol in patients undergoing postburn plastic surgery. Nan Fang Yi Ke Da Xue Xue Bao 2009:1255–6.
5
Wang F, Shen X, Xu S, Liu Y. Preoperative tramadol combined with postoperative small-dose tramadol infusion after total abdominal hysterectomy: a doubleblind, randomized, controlled trial. Pharmacol Rep 2009:1198–205.
6
Sittl R, Irnich D, Lang P. Update on preemptive analgesia: options and limits of preoperative pain therapy. Anaesthesist 2013:789–96.
7
Jabalameli M, Hazegh P, Talakoub R. Preemptive subcutaneous tramadol for post-operative pain in lower abdomen surgeries: a randomized double blinded placebo-control study. Adv Biomed Res 2013:68.
8
Pogatzki-Zahn E, Zahn P. From preemptive to preventive analgesia. Curr Opin Anaesthesiol 2006:551–5.
9
Cağıran E, Eyigör C, Sezer B, Uyar M. Preemptive analgesic efficacy of dexketoprofen trometamol on impacted third molar surgery. Agri 2014:29–33.
10
Farzi F, Nabi N, Mirmansouri B, Fakoor A, F, Roshan A, et al. Postoperative pain after abdominal hysterectomy: a randomized, double-blind, controlled trial comparing the effects of tramadol and gabapentin as premedication. Anesth Pain Med 2016:32360.
11
Dahl J, Moiniche S. Pre-emptive analgesia. British Medical Bulletin 2004:13–27.
12
Paz-Estrada C, Céspedes-Cuenca Y. Diclofenac versus metamizol in preventive analgesia for gynecological surgery. Rev Mex Anest 2009:209–13.
13
Aydede M. Does the IASP definition of pain need updating? Pain Rep 2019:777.
14
Lirk P, Thiry J, Bonnet M, Joshi G, Bonnet F. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med 2019:425–36.
15
Arbel R, Stanleigh J, Ioscovich A. Pain management following abdominal hysterectomy: novel approaches and review of the literature. J Clin Gynecol Obstet 2013:51–5.
16
Stoops W, Lofwall M, Nuzzo P, Craig L, Siegel A, Walsh S. Pharmacodynamic profile of tramadol in humans: influence of naltrexone pretreatment. Psychopharmacology (Berl) 2012:427–38.
17
Kocabas S, Karaman S, Uysallar E, Firat V. The use of tramadol and morphine for pain relief after abdominal hysterectomy. Clin Exp Obstet Gynecol 2005:45–8.
18
Mayhew D, Mendonca V, Murthy B. A review of ASA physical status -historical perspectives and modern developments. Anaesthesia 2019:373–9.
19
Farzi F, Nabi N, Mirmansouri B, Fakoor A, F, Roshan A, et al. Postoperative pain after abdominal hysterectomy: a randomized, double-blind, controlled trial comparing the effects of tramadol and gabapentin as premedication. Anesth Pain Med 2016:32360.
20
Mathew P, Aggarwal N, Kumari K, Gupta A, Panda N, Bagga R. Quality of recovery and analgesia after total abdominal hysterectomy under general anesthesia: a randomized controlled trial of TAP block vs epidural analgesia vs parenteral medications. J Anaesth Clin Pharmac 2019:170–5.
21
Xu Z, Zhang H, Luo J, Zhou A, Zhang J. Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post-operative pain of patients undergoing total knee arthroplasty. Phys Sportsmed 2017:316–22.
22
Solmaz F, Kovalak E. Comparison of tramadol/acetaminophen fixed-dose combination, tramadol, and acetaminophen in patients undergoing ambulatory arthroscopic meniscectomy. Acta Orthop Traumatol Turc 2018:222–5.
23
Metry A, Wahba R, Nakhla G, Abdelmalek F, Ragaei M, Fahmy N. Comparative study between preemptive intra-articular injection of levobupivacaine and tramadol for control of postoperative pain. Anesth Essays Res 2019:84–90.
24
Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006;(Suppl 1):17-S24.
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