The New Indian Journal of OBGYN. 12(1):87-92

Intraincisional bupivacaine versus tramadol for the relief of pain of the surgical site after caesarean section

Monika Ramola, Himanshi Rawat

ABSTRACT

Background: Caesarean section is associated with significant postoperative pain. Pain relief plays a significant role in favourable maternal and neonatal outcome. Both bupivacaine and tramadol have analgesic properties. Aim: The aim of this study is to compare the safety and efficacy of intraincisional bupivacaine and tramadol for the relief of pain of the surgical site after cesarean section. Methods: A single blind randomized control trial study was conducted on hundred women with singleton live pregnancy undergoing caesarean section under spinal anaesthesia over a period of one and a half years. At the time of closure of abdominal wall, the patient who were allocated to group A (50) received 0.25%of bupivacaine in dose of 0.7mg/kg diluted with normal saline to make a 20ml solution while those of group B (50) patients received 2mg/kg tramadol diluted with normal saline to make a 20ml solution in the rectus sheath and subcutaneous tissue. Postoperative pain was assessed by VAS score at 4, 8 and 12hours and additional analgesic requirement was noted in the first 24 hours. Patient satisfaction assessment was done by VAS score at 24 hours .Any side effect due to these drugs was noted. Results: Mean age in group A was 26.78±3.94 yrs and mean age in group B was 27.50 ±3.87 yrs. Mean VAS score at 4, 8 and 12 hours in group A was 2.72 ± 0.88, 4.64±1.01 and 5.80±0.99, whereas in group B was 2.84±1.11, 4.56±1.07 and 5.66± 0.98 respectively showing that pain relief was only slightly better in the bupivacaine group at 4 hours than in the tramadol group whereas at 8 and 12 hours tramadol showed better efficacy. 35 women in group A and 37 in group B expressed satisfactory post operative analgesic management in our study. Additional analgesic was not required in 16% of women postoperatively at 8 hours. Side effects were none in group A and only nausea and vomiting in one patient and headache in 2 patients in group B. Conclusion: This study concludes that infiltration of bupivacaine and tramadol at the surgical site can be considered safe and effective for pain relief.