Tramadol and its combination with piroxicam in post-cesarean pain management: a comparative study

Banapura Ambika, Mamatha K. R., Prabha P.


Background: Cesarean delivery is a major surgical procedure, requiring high quality pain relief to facilitate early ambulation, infant care and prevention of post-operative morbidity. There is no gold standard for post-cesarean pain management.

Methods: Cases were randomly assigned to 2 groups of 30 cases each. One group received Tramadol 100mg and another, Tramadol 100mg+ Piroxicam 20mg. Injections were given intramuscularly, postoperatively after skin closure. Diclofenac 75mg was the rescue analgesia. Primary outcome measure was control of pain, assessed by visual analogue scale (VAS). Secondary outcomes were sedation and time to rescue analgesia. Safety of the drugs was assessed by adverse drug reactions. Data was analysed by student’s t test, analysis of variance and post-hoc test.

Results: Multimodal group showed better analgesia compared to unimodal group (p<0001). Drowsiness was the main adverse effect in both treatment groups.

Conclusions: Multimodal analgesic combination of tramadol and piroxicam showed superior analgesic effect with better pain control and longer duration of action compared to tramadol alone.


Tramadol, Piroxicam, Post-cesarean pain

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