Evaluation of the effects of tramadol and diclofenac alone and in combination on post-cesarean pain


  • S. Mabu Shareef Department of Pharmacology, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Andhra Pradesh, India
  • I. Sridhar Department of Pharmacology, Govt. Medical College, Nizamabad, Andhra Pradesh, India
  • K. Madhu Dakshayani Department of Pharmacology, SVS Medical College, Mahabubnagar, Andhra Pradesh, India
  • Y. Venkata Rao Department of Pharmacology, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Andhra Pradesh, India
  • B. Santhamma Department of Pharmacology, Padmavathi Institute of Medical Sciences, Tirupathi, Andhra Pradesh, India


Tramadol hydrochloride, Diclofenac sodium, Post-cesarean pain


Background: Post-cesarean pain is a common cause of acute pain in the obstetrics. Pain in the postoperative period is an important impediment to recovery from surgery and anesthesia. This study was conducted to evaluate the efficacy of postoperative analgesia and incidence of side-effects of centrally acting drug tramadol with peripherally acting drug diclofenac alone and in combination in patients undergoing elective cesarean delivery under spinal anesthesia.

Methods: The study population of 90 patients was randomly divided into three groups of 30 each to receive the following treatments: tramadol (Group T), diclofenac (Group D), tramadol and diclofenac at reduced doses (Group TD).

Results: Combination of tramadol and diclofenac produced significantly early analgesia in comparison to tramadol or diclofenac alone and decrease in the incidence of side-effects.

Conclusion: We conclude that a multimodal approach to post-cesarean management with a combination of tramadol and diclofenac produced better analgesia than individual drugs and a reduction in the side-effects. Such a combination approach to relieve pain is more effective and advantageous.


Farshchi A, Ghiasi G. Comparison the analgesic effects of single dose administration of tramadol or piroxicam on postoperative pain after cesarean delivery. Acta Med Iran. 2010;48(3):148-53.

Desmeules J, Rollason V, Piguet V, Dayer P. Clinical pharmacology and rationale of analgesic combinations. Eur J Anaesthesiol Suppl. 2003;28:7-11.

Myles PS, Troedel S, Boquest M, Reeves M. The pain visual analog scale: Is it linear or nonlinear? Anesth Analg. 1999;89(6):1517-20.

Al-khtoum N. Comparative study of local infiltration of bupivacaine and parenteral administration of diclofenac sodium for post tonsillectomy pain in adults. Middle East J Fam Med 2006;4(3):53-3.

Zeidan A, Kassem R, Nahleh N, Maaliki H, El-Khatib M, Struys MM, et al. Intraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery. Anesth Analg. 2008;107(1):292-9.

Dixit JV. Principles and Practice of Biostatistics. 5th Edition. Jabalpur: Bhanaridas Bhanot Publishers; 2011: 213-7.

Chaturvedi S, Chaturvedi A. Post operative pain and its management. Indian J Crit Care Med. 2007;11(4):204.

Dayer P, Desmeules J, Collart L. Pharmacology of tramadol. Drugs. 1997;53 Suppl:18-24.

Mehta A, Bakshi R, Bhasin S. Efficacy of diclofenac sodium for post op pain relief in patients undergoing laparoscopic sterilization. Internet J Anesthesiol. 2007;16(1):5.

Rosenthal NR, Silverfield JC, Wu SC, Jordan D, Kamin M, CAPSS-105 Study Group. Tramadol/acetaminophen combination tablets for the treatment of pain associated with osteoarthritis flare in an elderly patient population. J Am Geriatr Soc. 2004;52(3):374-80.

Zuniga JR, Phillips CL, Shugars D, Lyon JA, Peroutka SJ, Swarbrick J, et al. Analgesic safety and efficacy of diclofenac sodium softgels on postoperative third molar extraction pain. J Oral Maxillofac Surg. 2004;62(7):806-15.

Delilkan AE, Vijayan R. Epidural tramadol for postoperative pain relief. Anaesthesia. 1993;48(4):328-31.

Prabhakar H, Shrirao SA, Shelgaonkar VC, Ghosh AA. Comparative evaluation of intramuscular ketoprofen and diclofenac sodium for post-operative pain relief. Internet J Anesthesiol. 2006;11(1):3.

Wilder-Smith CH, Hill L, Dyer RA, Torr G, Coetzee E. Postoperative sensitization and pain after cesarean delivery and the effects of single in doses of tramadol and diclofenac alone and in combination. Anesth Analg. 2003;97(2):526-33.

Hashmi ZA, Bashir G, Shah SA. Tramadol hydrochloride versus diclofenac sodium for early post-operative pain control. J Rawal Med Coll. 2006;10(2):90-3.




How to Cite

Shareef, S. M., Sridhar, I., Dakshayani, K. M., Rao, Y. V., & Santhamma, B. (2017). Evaluation of the effects of tramadol and diclofenac alone and in combination on post-cesarean pain. International Journal of Basic & Clinical Pharmacology, 3(3), 470–473. Retrieved from https://www.ijbcp.com/index.php/ijbcp/article/view/1007



Original Research Articles