Pre emptive analgesia for reducing pain after cholecystectomy: Oral tramadol vs. acetaminophen codeine

Authors
Sayyed Morteza Heidari Tabaei Zavareh
Parviz Kashefi
Mahmmoud Saghaei
Hale Emami
Department of Anesthesiology and critical care research center, Isfahan University of Medical sciences, Isfahan, Iran
Abstract
Background: Considering that protocols of postoperative pain management would be planned regarding the facilities of each center or region and the importance of its proper management to reduce its related complication and improve patient's satisfaction, in this study we compared the effect of orally administrated tramadol and acetaminophen-codeine in this regard.
Materials and Methods: In this prospective randomized double-blind clinical trial, 136 (68 in tramadol and 68 in acetaminophen codeine groups) ASA I and II patients scheduled for open cholecystectomy under general anaesthesia were enrolled. They randomly allocated to receive oral tramadol (50 mg capsule) or acetaminophen-codeine (325/10 mg) 1 hour before surgery. After surgery they evaluated for postoperative pain using VAS score, analgesic consumption and vomiting.
Results: Mean of postoperative pain score during 24 hours after surgery was 2.1 ± 1.0 and 3.8 ± 2.0 in tramadol and acetaminophen-codeine groups, respectively (P < 0.05). Mean of analgesic consumption (morphine) during 24 hours after surgery was 6.2 ± 4.4 mg and 12.9 ± 5.7 mg in tramadol and acetaminophen-codeine groups, respectively (P < 0.05). Mean of vomiting during 24 hours after surgery was 1.2 ±0.9 and 0.4 ± 0.5 in tramadol and acetaminophen-codeine groups, respectively (P < 0.05).
Conclusion: The findings of current study indicated that in lower dose of tramadol (50 mg) and acetaminophen/codeine (325 mg/10 mg) the analgesic effect of tramadol is better and its side effects are higher than acetaminophen/codeine, which limit its use for mentioned purpose. It seems that administration of each of studied agents it depends on patients' tolerance and decision of the physician.
Keywords
Acetaminophen codeine
postoperative pain
tramadol
1. de Beer Jde V, Winemaker MJ, Donnelly GA, Miceli PC, Reiz JL, Harsanyi Z, et al. Efficacy and safety of controlled-release oxycodone and standard therapies for postoperative pain after knee or hip replacement. Can J Surg 2005;48:277-83.  Back to cited text no. 1
    
2. Recart A, Duchene D, White PF, Thomas T, Johnson DB, Cadeddu JA. Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy.J Endourol 2005;19:1165-9.  Back to cited text no. 2
    
3. Watcha MF, Issioui T, Klein KW, White PF. Costs and effectiveness of rofecoxib, celecoxib, and acetaminophen for preventing pain after ambulatory otolaryngologic surgery. Anesth Analg 2003;96:987-94.  Back to cited text no. 3
    
4. Ramsay MA. Acute postoperative pain management. Proc (Bayl Univ Med Cent) 2000;13:244-7.  Back to cited text no. 4
    
5. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 2009;2:588-93.  Back to cited text no. 5
    
6. Toms L, McQuay HJ, Derry S, Moore RA. Single dose oral paracetamol (acetaminophen) forpostoperative pain in adults. Cochrane Database Syst Rev 2008;CD004602.  Back to cited text no. 6
    
7. Toms L, Derry S, Moore RA, McQuay HJ. Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev 2009;CD001547.  Back to cited text no. 7
    
8. Barden J, Edwards J, Moore A, McQuay H. Singledoseoralparacetamol (acetaminophen) for postoperative pain. Cochrane Database Syst Rev. 2004;CD004602.  Back to cited text no. 8
    
9. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004;43:879-923.  Back to cited text no. 9
    
10. le Roux PJ, Coetzee JF.Tramadoltoday. CurrOpin Anaesthesiol 2000;13:457-61.  Back to cited text no. 10
    
11. But AK, Erdil F, Yucel A, Gedik E, Durmus M, Ersoy MO. The effects of single-dose tramadol on post-operative pain and morphine requirements after coronary artery bypass surgery. Acta Anaesthesiol Scand 2007;51:601-6.  Back to cited text no. 11
    
12. Kaye K, Theaker N. TRAMADOL;A Position Statement of the NSW Therapeutic Assessment Group Inc.Sydney: NSW TAG, September 2001:1-15.  Back to cited text no. 12
    
13. Moore RA, Derry S, McQuay HJ, Wiffen PJ. Singledoseoralanalgesics for acutepostoperative pain in adults. Cochrane Database Syst Rev. 2011;CD008659.  Back to cited text no. 13
    
14. DRUGS@FDA page. U.S. Food and Drug Administration Web site. Available from: http://www.fda.gov/Drugs/default.htm Accessed May 1, 2011.   Back to cited text no. 14
    
15. Toms L, Derry S, Moore RA, McQuay HJ. Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev. 200921;CD001547.  Back to cited text no. 15
    
16. Budd K, Langford R. Tramadol revisited (Editorial). Brit J Anaesth 1999; 82:493-95.  Back to cited text no. 16
    
17. Nossaman VE, Ramadhyani U, Kadowitz PJ, Nossaman BD. Advances in perioperative pain management: use of medications with dual analgesic mechanisms, tramadol and tapentadol. AnesthesiolClin. 2010;28:647-66.  Back to cited text no. 17
    
18. Liukkonen K, Santanen U, Pere P, Erkola O, RautomaP.Perora; Tramadol premedication increases postoperative nausea ans delays home-readiness in day-case knee arthroscopy patients. Scandinavian Journal of Surgery 2002; 91: 365-8.  Back to cited text no. 18
    
19. Pluim MA, Wegener JT, Rupreht J, Vulto AG. Tramadol suppositories are less suitable for post-operative pain relief than rectal acetaminophen/codeine. Eur J Anaesthesiol 1999;16:473-8.  Back to cited text no. 19
    
20. Rawal N, Allvin R, Amilon A, Ohlsson T, Hallén J. Postoperative analgesia at home after ambulatory hand surgery: A controlled comparison of tramadol, metamizol, and paracetamol. Anesth Analg 2001;92:347-51.  Back to cited text no. 20
    
21. Jung YS, Kim DK, Kim MK, Kim HJ, Cha IH, Lee EW.Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/acetaminophen/ibuprofen in acute postoperative pain: A single-center, single-dose, randomized, active-controlled, parallel-group study in a dental surgery pain model. ClinTher 2004;26:1037-45.  Back to cited text no. 21
    
22. Rawal N, Macquaire V, Catalá E, Berti M, Costa R, Wietlisbach M. Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: A double-blind, double-dummy, randomized, parallel-group trial. J Pain Res 2011;4:103-10.  Back to cited text no. 22
    
 
Advanced Biomedical Research
Volume 2013, March
March 2013
Pages 1-5