A PROSPECTIVE STUDY TO ASSESS THE EFFECTIVENESS OF PRE-EMPTIVE ANALGESIA USING TRAMADOL VERSUS FENTANYL ON POST-OPERATIVE PAIN MANAGEMENT IN ORTHOPEDIC SURGERY PATIENTS
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Keywords
Pre-emptive analgesia, Tramadol, Fentanyl, Orthopedic surgery, Postoperative pain management
Abstract
Introduction: Pre-emptive analgesia prevents central sensitization by administering analgesics before noxious stimuli. This study compared the effectiveness of tramadol versus fentanyl for pre-emptive analgesia in orthopedic surgery patients, addressing the need for optimal perioperative pain management strategies with minimal adverse effects.
Methods: A prospective, randomized, double-blind, controlled trial was conducted at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences from April to September 2015. Ninety patients undergoing elective orthopedic surgery were randomly allocated to receive tramadol 2 mg/kg (n=30), fentanyl 2 μg/kg (n=30), or normal saline placebo (n=30) intravenously after anesthesia induction. Primary outcomes included Visual Analog Scale pain scores, rescue analgesic requirements, and adverse events over 24 hours postoperatively.
Results: Both active treatments significantly reduced pain scores compared to control (p<0.001). Fentanyl provided superior early analgesia at 1-2 hours postoperatively, while tramadol demonstrated longer duration of effect with time to first rescue analgesia of 6.8±2.4 hours versus 4.2±1.8 hours for fentanyl (p<0.001). Tramadol group required fewer total rescue analgesics (2.3±1.4 vs 3.1±1.6 doses, p<0.05) and had significantly lower incidence of sedation (13.3% vs 46.7%), respiratory depression (0% vs 10.0%), and pruritus (6.7% vs 26.7%) compared to fentanyl. Patient satisfaction scores were highest in tramadol group (4.2±0.8 vs 3.8±0.9, p<0.05).
Conclusion: Both tramadol and fentanyl provide effective pre-emptive analgesia, but tramadol offers superior sustained pain relief with fewer adverse effects, making it the preferred choice for orthopedic surgery pre-emptive analgesia protocols.
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Dr. Manoj Kantilal Parikh
Assistant Professor, Department of Anaesthesia, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Krishna, AP