1. 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.

2. 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.

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

4. 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.

5. 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

6. 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

7. 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

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

9. 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.

10. 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.

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

12. 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 MINS(±58.5).

13. 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.

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

15. THANK YOU