Comparative evaluation of analgesic efficacy of tramadol and diclofenac-sodium in post-operative orthopedic patients


  • Rama Paudel Department of Pharmacology, Universal College of Medical Sciences-Teaching Hospital, Bhairahawa, Nepal
  • Anjali Deka Department of Pharmacology, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal
  • Hemant Kumar Gupta Department of Orthopedics, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal
  • Hari Prasad Nepal Department of Microbiology, Trinity School of Medicine, St. Vincent and the Grenadines



Analgesic efficacy, Diclofenac, Post-operative orthopedic pain, Tramadol, VAS


Background: Post-operative pain management is an important consideration in the orthopedic department. The purpose of this study was to compare the analgesic efficacy of tramadol with diclofenac sodium in patients with postoperative orthopedic pain.

Methods: A hospital based, prospective, observational study was undertaken in Department of Orthopedics for a period of one year. A group of 60 patients having post-operative pain intensity assessed as 6cm or more on a 10cm visual analogue scale (VAS) were assigned to receive either tramadol thrice a day (n=30) or diclofenac sodium thrice a day (n=30). Both drugs were administered parenterally for initial 24hr, then orally for next 96 hr. The primary efficacy outcome measures were pain intensity difference assessed at 2hr, 4hr, 8hr, 16hr, 24hr, 32hr, 40hr, 48hr, 56hr, 64hr, 72hr, 80hr, 96hr, 104hr, 112hr and 120hr using a VAS and sum of pain intensity differences assessed at 8hr, 24hr, 48hr, 72hr, 96hr and 120hr whereas secondary efficacy measures included maximum fall in pain intensity, number of patients who required rescue medication and their quality of sleep in the night.

Results: Mean pain intensity differences assessed on 10cm VAS were significantly better for tramadol group compared to diclofenac group at all the time points except 88 hr. Sum of pain intensity differences over 8hr, 24hr, 48hr, 72hr, 96hr and 120 hr for the tramadol group was significantly superior than diclofenac group. Maximum fall in pain intensity score was also significantly superior in the tramadol group as compared to the diclofenac group. However, no patients required rescue medication in either of the groups. Patient’s quality of sleep improved with both drugs but tramadol produced significantly better quality of sleep every night than did diclofenac. Both the study medications produced effective analgesia and were well tolerated with no incidence of serious adverse effects throughout the study.

Conclusions: Tramadol has a more pronounced analgesic effect than diclofenac. Thus, tramadol can be considered as an effective alternative to traditional NSAIDs in the treatment of post-operative pain.


Williams M, Kowaluk EA, Arneric SP. Emerging molecular approaches to pain therapy. J Med Chem. 1999;42:1481-500.

Lanzetta A, Vizzardi M, Letizia G, Martorana U, Sanfillipo A, Osti L. Intramuscular tramadol versus ketorolac in patients with orthopedic and traumatologic post-operative pain: a comparative multicenter trial. Curr Ther Res. 1998;59(1):39-47.

Pareek A, Chandurkar N, Gupta A, Desai Y, Kumar SH, Swamy A, et al. Comparative evaluation of efficacy and safety of etodolac and diclofenac sodium injection in patients with post-operative orthopedic pain. Curr Med Res Opin. 2011;27(11):2107-15.

Khosraftar E, Anvari HM, Assadi HK, Abdulamir AS, Abubakar F. Comparative study on the effectiveness of acetaminophen and diclofenac pretreatment in the relief of acute pain after outpatient surgery. Eur J Dent Med. 2011;3(1):23-7.

Hynes D, McCarroll M, Provost OH. Analgesic efficacy of parenteral paracetamol and diclofenac in post-operative orthopaedic pain. Acta Anaesthesiol Scand. 2006;50:374-81.

Fields M, Murray S. The effectiveness of Tramadol in acute pain management. Accident Compensation corporation. Available at: (accessed 1 December 2013).

Beck A, Krishchak G, Sorg T, Augat P, Farker K, Merkel U, et al. Influence of diclofenac (group of nonsteroidal anti-inflammatory drugs) on fracture healing. Arch Orthop Trauma Surg. 2003;123:327-32.

Ofman JJ, MacLean CH, Straus WL, Morton SC, Berger ML, Roth EA, Shekelle P. A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. The Journal of rheumatology. 2002 Apr 1;29(4):804-12.

Pagliara L, Tornago S, Metastasio J, Peretti G, Albisetti W, Thovez G. Tramadol compared with diclofenac in traumatic musculoskeletal pain. Curr Ther Res. 1997;58(8):473-80.

Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and non-opioid component independently contribute to the mechanism of action of tramadol, an atypical opioid analgesic. J Pharmacol Exp Ther. 1992;260:275-85.

Tripathi KD. Opioid Analgesics and antagonists. In: Tripathi KD, editor. Essentials of Medical Pharmacology. 6th Ed. New Delhi: Jaypee Brothers; 2008:453-468.

Alwan AM, Aljibori AS, Shinawa RM. Comparision of post tonsillectomy analgesic drugs (paracetamol, diclofenac sodium, and tramadol). Tikrit J Pharm Sci. 2009;5(2):156-9.

Shah I, Zaeem K, Ibrahim MW, Hussain I, Hassan A. Comparision of analgesic efficacy of tramadol hydrochloride with diclofenac sodium in dento-alveolar surgery. Pak Oral Dent J. 2008;28(2):241-4.

Joshi VS, Vyavahare RD, Khade G, Shiledar V, Jamadar NP. Comparative study of analgesic efficacy of rectal suppository of tramadol versus diclofenac in suppressing post-operative pain after cesarean section. Int J Health care Biomed Res. 2013;1(2):32-7.

Courtney MJ, Cabraal D. Tramadol Vs diclofenac for post tonsillectomy analgesia. Arch Otolaryngol Head Neck Surg. 2001;127:385-8.

Melzack R. The McGill pain questionnaire: Major properties and scoring methods. Pain. 1975;1(3):277-99.

Gould D. Information point: visual analogue scale (VAS). J Clin Nurs. 2001;10:697-706.

Daniels S, Melson T, Douglas A, Hamilton DA, Lang E, Carr DB. Analgesic efficacy and safety of a novel injectable formulation of diclofenac compared with intravenous ketorolac and placebo after orthopedic surgery: a multicenter, randomized, double-blinded, multiple-dose trial. Clin J Pain. 2013;29(8):655-63.

Beaulieu AD, Peloso PM, Haraoui B, Bensen W, Thomson G, Wade J, et al. Once-daily, controlled-release tramadol and sustained-release diclofenac relieve chronic pain due to osteoarthritis: a randomized controlled trial. Pain Res Manage. 2008;13(2):103-10.

Mizraji M. Clinical response to etodolac in the management of pain. Eur J Rheumatol Inflamm. 1990;10(1):35-43.

Comfort MB, Tse AS, Tsang AC, McGrath C. A study of the comparative efficacy of three common analgesics in the control of pain after third molar surgery under local anaesthesia. Aust Dent J. 2002;47:327-30.

Cander B, Girisgin S, Koylu R, Gul M, Kocak S. The effectiveness of analgesics in traumatic injuries of the extremities. Adv Ther. 2005;22(5):462-6.

Kupers R, Callebaut V, Debois V, Camu F, Verborgh C, Coppejans H, et al. Efficacy and safety of oral tramadol and pentazocine for postoperative pain following prolapsed intervertebral disc repair. Acta Anaesthesiologica Belgica. 1994 Dec;46(1):31-7.

Lehmann KA. Tramadol for the management of acute pain. Drugs. 1994;47(1):19-32.

Tfelt-Hansen P, McCarroll K, Lines C. Sum of Pain Intensity Differences (SPID) in migraine trials. A comment based on four rizatriptan trials. Cephalalgia. 2002;22:664-6.

Richter W, Barth H, Flohe L, Giertz H. Clinical investigation on the development of dependence during oral therapy with tramadol. Arzneimittelforschung. 1985;35:1742-4.




How to Cite

Paudel, R., Deka, A., Gupta, H. K., & Nepal, H. P. (2017). Comparative evaluation of analgesic efficacy of tramadol and diclofenac-sodium in post-operative orthopedic patients. International Journal of Basic & Clinical Pharmacology, 6(11), 2676–2683.



Original Research Articles