The aim of this study is to compare the analgesic efficacy of intraincisional infiltration of Inj. Tramadol versus Inj. Bupivacaine for postoperative pain relief in Caesarean section under spinal anaesthesia and to compare postoperative pain scores and total consumption of rescue analgesics.
Materials and Methods: This study was carried out in the Department of Obstetrics and Gynaecology in Rajah Muthiah Medical College and Hospital from 2018 -2020 after getting the approval of Ethical Committee. Sixty Antenatal mothers of age group (18-35 yrs) with BMI (18.5 – 40 Kg/m2) scheduled for caesarean under spinal anaesthesia were included in the study. Patients under exclusion criteria were excluded in this study. Informed written consent was obtained prior to procedure. Under spinal anaesthesia caesarean section was performed. At the time of skin closure patients were randomly divided into two groups. Group A (n=30) – treated with Inj. Tramadol 40 mg. Group B (n= 30) – treated with Inj. Bupivacaine 0.25% 0.7 mg/kg. All drugs were diluted with sterile normal saline to 20 ml solution and administered intraincisionally at the time of skin closure. On arrival in recovery room, pain intensity is assessed by Visual Analogue Scale ranging from 0 to 10 and then 15, 30, 60 minutes, 2 hrs, 6 hrs, 12 hrs, 24 hrs after arrival from recovery. If analgesia is considered inadequate, rescue analgesics Inj. Diclofenac 75 mg intramuscular or Inj. Tramadol 1mg/kg intramuscular was added. The frequency of nausea, vomiting, rigor and mean arterial blood pressure were evaluated.At the end of 24 hours patients were asked about the quality of pain relief using the following score – excellent – 4,very good-3, good -2, poor-1.
Results: Demographic data - age distribution, BMI, gravidity showed no significant difference. Mean age, BMI group A 25.43 ± 3.61, 25.11 ± 3.61 and Group B was 25.03 ± 4.26, 23.37 ± 2.74. Both were homogenous. Mean Pain scores by Visual analogue scale for group A was 0.76 ± 1.16, 1.90 ± 0.92 and 0.97 ± 1.12 and for group B was 0.53 ± 0.68, 1.17 ± 0.74 and 0.30 ± 0.53 at 6, 12 and 24 hours. The pain score was slightly higher in Group B than Group A. The ‘f’ value of Group B is higher in nature but the Pain score was statistically significant ‘P’ of 0.001 was obtained for both groups. Group B was more effective in postoperative analgesia but Group A also has significant postoperative analgesic effect. The Mean Systolic and Diastolic BP is higher in Group B. Also the Systolic BP was statistically significant. On comparing complications 2 patients reported nausea in Group A and 6 patients reported rigors in Group B.
Conclusion: In this comparative study, even though Bupivacaine had better analgesic effect, Tramadol also proved to have significance in pain scores and prolonged analgesic effect and less complications. Therefore Intraincisional infiltration of Tramadol and Bupivacaine before skin closure in caesarean sections prolonged the postoperative analgesic effect, reduced consumption of rescue analgesics, better compliance for mother and baby and enhanced patient satisfaction