DR.O.SUGANYA MANOHARAN CO AUTHORS PROF.DR.R SELVAKUMAR

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Presentation transcript:

COMPARISON OF RECTAL TRAMADOL WITH DICLOFENAC FOR PROVIDING POST OP ANALGESIA IN CAESAREAN SECTIONS DR.O.SUGANYA MANOHARAN CO AUTHORS PROF.DR.R SELVAKUMAR PROF.DR.B.CHANDRIKA PROF.DR.A.CHANDRASEKARAN COIMBATORE MEDICAL COLLEGE,CBE.

INTRODUCTION *MODALITIES OF POSTOPERATIVE ANALGESIA ARE MANY. *RECTAL ROUTE IS ONE AMONG THEM AND IT IS EASIER AND MORE PATIENT COMPATIBLE. *TRAMADOL IS THE RECENT ENTRY IN SUPPOSITORY FORM.

AIM TO COMPARE TRAMADOL AND DICLOFENAC SUPPOSITORY FOR THEIR ANALGESIC EFFICACY,SIDE EFFECTS AFTER LSCS.

MATERIALS & METHODS DOUBLE BLINDED PROSPECTIVE STUDY 2 GROUPS OF 20 PTS EACH UNDERGOING LSCS UNDER SPINAL ANAESTHESIA ARE SELECTED TO RECEIVE EITHER RECTAL TRAMADOL 100MG OR DICLOFENAC 100MG POST OPERATIVELY.

OBSERVATION DEMOGRAPHIC PROFILE TRAMADOL GROUP DICLO GROUP SIGNIFICANCE AGE 25.1±2.9 24.3±3.1 P >0.05 NOT SIGNIFICANT HEIGHT 154.5±5.02 152.2±4.43 WEIGHT 55.35±4.1 53.55±5.2

OBSERVATION DURATION OF ANALGESIA WITH VAS LESS THEN 4 TRAMADOL GROUP mean±SD (mins) DICLOFENAC GROUP mean±SD SIGNIFICANCE 297±65.64 170.5±58.4 P <0.05 SIGNIFICANTLY HIGHER

OBSERVATION DURATION OF ANALGESIA WITH VAS >4 TILL THE PTS REQUIRE RESCUE ANALGESIA TRAMADOL GROUP mean±SD(mins) DICLOFENAC GROUP SIGNIFICANCE 363±94 221.5±75.43 P <0.05 SIGNIFICANTLY HIGHER

SIDE EFFECTS TRAMADOL GROUP DICLOFENAC GROUP NAUSEA 45% 50% VOMITING 25% 35% EXPULSION 5%

DISCUSSION BRIEF PHARMACOLOGY DICLOFENAC- NSAID. TRAMADOL –SYNTHETIC 4-PHENYL PIPERIDINE ANALOGUE OF CODEINE, METABOLIZED BY DEMETHYLATION IN LIVER AND EXCRETED THROUGH KIDNEY, IT INHIBITS NA & SERATONIN REUPTAKE AT NERVE TERMINALS THUS ACTIVATING MONOAMINERGIC SPINAL INHIBITION OF PAIN, DICLOFENAC- NSAID. ARYL ACETIC ACID DERIVATIVE. INHIBITS CYCLO OXYGENASE ENZYME. INHIBITS PG SYNTHESIS & HAVE ANTI-PLATELET ACTION.

REVIEW OF LITERATURE EFFECT OF RECTAL DICLOFENAC IN REDUCING POST OP PAIN AND RESCUE ANALGESIA AFTER CARDIAC SURGERIES-DHAWAN,KIRAN,CARDIOTHORACIC CENTRE, AIIMS,NEW DELHI. OPIOD SPARING EFFECT OF RECTAL DICLOFENAC FOLLOWING TOTAL ABDOMINAL HYSTERECTOMY BENEFITS THE PATIENTS BY DR.J.ANAES,2002.

REVIEW OF LITERATURE EFFECT OF DICLOFENAC SUPPOSITORY ON TRAMADOL CONSUMPTION IN POST HYSTERECTOMY PAIN BY HOSSCU DEPT.OF ANAESTHESIA,AGAKHAN UNIVERSITY,KARACHI.

SUMMARY 40 PATIENTS UNDERGOING LSCS ARE SELECTED,20 PATIENTS RECEIVE RECTAL TRAMADOL,20 PATIENTS RECEIVE RECTAL DICLOFENAC. TRMADOL SUPPOSITORY HAD A PAIN FREE PERIOD OF 297 MINS(±65.6) COMPARED WITH DICLOFENAC HAVING A PAIN FREE PERIOD OF 170.5 MINS(±58.5).

SUMMARY DURATION OF ANALGESIA TILL THE PTS REQUIRING RESCUE ANALGESIA WITH TRAMADOL IS 363MINS(±94) WHILE FOR DICLOFENAC 221.5MINS(±75.4). SIDE EFFECTS EQUAL FOR BOTH GROUPS.

CONCLUSION RECTAL TRAMADOL PROVIDES BETTER AND PROLONGED POST OP PAIN RELIEF COMPARED TO DICLOFENAC IN PTS UNDERGOING LSCS WITH COMPARABLE SIDE EFFECTS.

THANK YOU