Comparison of the analgesic effects of paracetamol and tramadol in lumbar disc surgery

Abstract

IntroductionDespite developments in the pathophysiology and treatment of pain, increased knowledge of pain management, the availability of new drugs, and complex drug delivery systems, the pain management of many patients after surgery remains inadequate. Studies have shown that successful postoperative analgesia after surgery prevents many side effects of pain, such as the inability to breathe at ease, the increase in the workload of the cardiovascular system, the development of thromboembolic events due to a delay in the mobilization of patient, and the increase in stress response due to the activation of the sympathetic nervous and neuroendocrine systems (1,2). Inadequate treatment of acute pain is the most common cause of chronic pain after surgery. The aim after surgery is to ensure that organ functioning returns to normal quickly by controlling pain as soon as possible (3).Today it is possible to achieve successful postoperative analgesia by selecting appropriate methods/routes of administration, agents, dosages, and dosage ranges. Opioids are the most widely used group of drugs in the treatment of postoperative pain due to their strong analgesic activities. However, opioid-related nausea, vomiting, pruritus, urinary retention, respiratory depression, sedation, and central nervous system depression have accelerated the search for analgesic drugs with better pain relief efficacy and fewer side effects (4).Research has reported gastric irritation, erosion, bleeding, and inhibition of platelet aggregation with nonsteroidal antiinflammatory drugs (NSAIDs), in addition to adverse effects on the secretion of uric acid and bleeding (5), thereby restricting their use. Side effects, such as systemic toxicity and prolonged sensory and motor responses, have also been reported with local anesthetic drugs used to provide pain control (6). Tramadol, a weak, effective synthetic opioid, has been shown to have relatively few side effects compared to other opioids, and its abuse or addiction potential is negligible (7). Paracetamol is a Background/aim: To compare the postoperative analgesic efficacy and side effects of paracetamol and tramadol in patients undergoing lumbar disc surgery. Materials and methods: Group P (paracetamol group) was given 1 g of paracetamol intravenously 30 min before the end of the operation and 1 g each day at 6-h intervals. Group T (tramadol group) was given 1.5 mg/kg of tramadol as a loading dose and patient-controlled analgesia for 1 day. Hemodynamic parameters, modified Aldrete score, Ramsay sedation scale score, patient satisfaction scale (PSS) score, visual analog scale (VAS) score, nausea/vomiting scale score, and additional analgesic needs/times were recorded.Results: PSS scores were significantly higher in Group T (P < 0.05). The total analgesic consumption was significantly higher in Group P. There were no significant differences in the VAS scores at any time points. Twenty-one patients in Group P and 8 patients in Group T needed additional analgesia (P < 0.05). The first additional analg...

Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

“…Our results are in concordance with the studies by Yilmaz et al and Cakan et al, although they combined paracetamol with tramadol and morphine 24,29 . Despite the more eff ective control of postoperative pain by opioid analgesics, paracetamol alone may be considered as an effi cacious analgesic for postoperative pain relief following lumbar disc surgery.…”

“…Th ere are diff erences in the effi cacy of analgesics according to pain type, pain location and methods of pain relief. Studies of analgesic effi cacy of various drugs are necessary and important 24 . However, trial data on analgesic therapy after spinal surgery are limited, and there are great differences in management practices.…”

“…Side eff ects such as gastric irritation, inhibition of platelet aggregation and bleeding have restricted their wide use 23 . Paracetamol is one of the nonselective cyclooxygenase inhibitors, acting by inhibiting the synthesis of prostaglandins and other substances that sensitize pain receptors in the central nervous system and periphery 24 . Th is drug is an effi cacious analgesic agent and has no side eff ects that are observable with opioids or NSAIDs 25 .…”

Pain management following spinal surgeries: An appraisal of the available options

“…Mechanisms of action of paracetamol are speculative and may involve central and peripheral sites of action,[ 34 35 ] inhibition of prostaglandins,[ 36 ] and inhibition of descending serotoninergic pathways. [ 37 ] Paracetamol as the sole agent may not be useful as an analgesic agent[ 38 39 ] nonetheless combination therapy with opioids have shown to result in decreasing opioid consumption substantially. [ 40 41 ] In spite of the popular perception that acetaminophen has opioid sparing effects, some authors have contradicted the claims of reduction in opioid consumption following administration of acetaminophen.…”

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

“…The 29 RTCs that tested therapies administered during the intraoperative period included systemic pharmacological therapies (19 studies) and locoregional anesthetic drugs (10 studies) (see Table ).…”