Publication:

Efficacy of local infiltration tramadol (transversus abdominis plane block technique) versus preemptive intravenous tramadol on postoperative pain after open appendectomy: a prospective randomized controlled trial

Background Acute postoperative pain, if mismanaged, leads to increased morbidity and mortality. Effective perioperative analgesia is crucial to prevent persistent pain. In abdominal surgeries, endogenous opioids are released, and tramadol, a weak synthetic opioid, has demonstrated effective analgesic properties. Recent studies suggest tramadol's mechanism involves blocking voltage-dependent sodium channels, which increases extracellular calcium and affects peripheral nerves. This suggests tramadol has both systemic and local anesthetic effects.

Methods A prospective, randomized, double-blind study was conducted on 32 patients (ages 18–60) diagnosed with acute appendicitis who underwent open appendectomy under general anesthesia. Participants were randomly assigned to two groups: group 1 received normal saline with tramadol infiltration for transversus abdominis plane (TAP) block (n=16), and group 2 received preemptive intravenous tramadol with TAP normal saline infiltration (n=16). Pain was assessed using the visual analogue scale (VAS) at various postoperative intervals. Opioid consumption was monitored through patient-controlled analgesia (PCA), and intraoperative data, complications, and hospital stay were recorded.

Results Demographic data were similar between groups. The primary outcome showed a significant reduction in postoperative pain (VAS score) at 0 hours (p=0.031) for the tramadol TAP group, with a 1-point reduction in pain over 24 hours compared to the intravenous group. Secondary outcomes indicated reduced opioid consumption, with no significant differences in complications (nausea/vomiting, infection, hospital stay).

Conclusions Local tramadol combined with TAP block is an effective alternative for postoperative pain relief after open appendectomy, reducing opioid consumption without additional complications.