Comparative study of tramadol and piroxicam as analgesic for postoperative pain in patients operated for inguinal hernia and hydrocele
Keywords:Analgesic efficacy, Analgesia, Pain assessment, Visual analog scale
Background: Pain is usually protective, it warns of tissue damage and prompts treatment but postoperatively, it can delay recovery. Postoperative pain is both distressing and detrimental for the patient. Postoperative pain may be a significant reason for delayed discharge from hospital, increased morbidity and reduced patient satisfaction.
Methods: This was a hospital based prospective, randomized, comparative, observational study conducted over a period of one year. Patients operated for hydrocele and inguinal hernia were included in the study after applying the inclusion and exclusion criteria. For the purpose of study, equal numbers of subjects were randomly allocated one of the two analgesic protocols. Pain assessment was done by using visual analog scale (VAS) for the first 72 hours of the postoperative period.
Results: When the drugs were compared individually, piroxicam was superior to tramadol in first 24, 48 and 72 hours of postoperative period in case of pain after surgery for hernia. Piroxicam was found to be superior to tramadol in first postoperative 24 hours after surgery for hydrocele with no significant difference first 48 & 72 hours of postoperative period. Piroxicam has the advantage of requiring lesser frequency of administration than tramadol due to prolonged duration of action.
Conclusions: Piroxicam provides better and effective analgesia in acute post-operative pain along with the advantage of requiring lesser frequency of administration than tramadol.
Mersky H. Pain terms: a list with definitions and notes on usage. Recommended by the IASP subcommittee on taxonomy. Pain. 1979;6:249-52.
Rathmell JP, Howard HL. Pain: pathophysiology and management. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's principles of internal medicine. 19 ed. New York, NY: McGraw-Hill; 2015:87.
Ryhanen P, Adamski J, Puhakka K. Post-operative pain relief in children. Anaesthesia. 1994;49(1):57-61.
Rahman MH, Beattie J. Managing post-operative pain. The Pharm J. 2005;275:145-8.
Jarrett PEM. Day case surgery. Surgery. 1995;13(1):5-7.
Wantz GE. Ambulatory hemia surgery. Br J Surg. 1989;76(12):1228-9.
Munro HM, Riegger LQ, Reynolds PI, Wilton NCT, Lewis IH. Comparison of the analgesic and emetic properties of ketoralac and morphine for paediatric outpatient strabismus surgery. Br J Anaesth. 1994;72(6):624-8.
Moffat AC, Kenny GNC, Prentice JW. Post-operative nefopam and diclofenac. Anaesth. 1990;45(4):302-5.
Grosser T, Smyth E, Fitzgerald GA. anti-inflammatory, antipyretic, and analgesic agents; pharmacotherapy of gout. In: Brunton LB, Chabner BA, Knollman BC, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-Hill; 2011: 989-990.
Duthie DJ. Remifentanil and tramadol. Br J Anaesth. 1998;81(1):51-7.
Gallagher EJ, Bijur PE, Latimer C, Silver W. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 2002;20(4):287-90.
Andréou A, Sibert L, Montes R, Hacpille L, Pfister C, Grise P. Randomized study comparing piroxicam analgesia and tramadol analgesia during outpatient electromagnetic extracorporeal lithotripsy. Progres en Urologie. 2006;16(2):155-9.
Farshchi A, Ghiasil G. Comparison the analgesic effects of single dose administration of tramadol or piroxicam on postoperative pain after cesarean delivery. Acta Medica Iranica. 2010:48(3):148-53.
Rational use of NSAIDs for musculoskeletal disorders. Drug Ther Bull. 1994;32(12):91-5.
Tverskoy M, Cozacov C, Ayache M, Bradley EL Jr, Kissin I. Post-operative pain after inguinal herniorraphy with different types of anaesthesia. Anesth Analg. 1990;70(1):29-35.
Vickers MD, Paravicini D. Comparison of tramadol with morphine for postoperative pain following abdominal surgery. Eur J Anaesthesiol. 1995;12(3):265-71.
Demiraran Y, Kocaman B, Akman RY. A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children. Br J Anaesth. 2005;95(4):510-3.
Oxford league table of analgesic efficacy. http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/lftab. Accessed on 25 February, 2016.
Stubhaug A, Grimstad J, Breivik H. Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind, placebo and standard active drug comparison. Pain. 1995;62(1):111-8.
Isiordia-Espinoza MA, de Jesús Pozos-Guillén A, Aragon-Martinez OH. Analgesic efficacy and safety of single-dose tramadol and non-steroidal anti-inflammatory drugs in operations on the third molars: a systematic review and meta-analysis.Br J Oral Maxillofac Surg. 2014;52(9):775-83.
Turturro MA, Paris PM, Larkin GL. Tramadol versus hydrocodone-acetaminophen in acute musculoskeletal pain: a randomized, double-blind clinical trial. Ann Emerg Med. 1998;32(2):139-43.
White PF. The role of nonopioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analog. 2002;94(3):577-85.