Comparison of the Effectiveness of Unimodal Opioid Analgesia with Multimodal Analgesia in the Management of Postoperative Pain in Patients Undergoing Surgery under Spinal Anesthesia-Double Blind Study

Abstract

Objective: To evaluate the efficacy and safety of opioid analgesic alone or in combination with a Non-steroidal Anti-inflammatory Drug (NSAID) in management of post-operative pain after regression of spinal anesthesia. Methods:In this double-blind study, 120 patients who underwent infra-umbilical surgeries under spinal anesthesia were chosen for the study and were randomly allocated into 4 groups of 30 each. Each group received Tramadol 100 mg or Pentazocine 30 mg or Tramadol 100 mg+Piroxicam 20 mg or Pentazocine 30 mg+Piroxicam 20 mg intramuscularly, 30 minutes after the end of the surgery. The primary efficacy end points were the total duration of post-operative analgesia and the intensity of pain relief in different groups, as assessed by VAS. Level of sedation and incidence of side effects were observed as secondary outcomes. Results:The mean VAS scores of the patients in Pentazocine group was lower, hence better pain relief, than Tramadol group at all time periods. The mean VAS score of the patients in Pentazocine+Piroxicam was lower than Tramadol+Piroxicam group.In the inter-group comparison of VAS, between all 4 groups, it was observed that VAS, pain score was least for Pentazocine+Piroxicam group and highest for Tramadol group. In this comparison, it was observed that the Ramsay sedation score was highest for Pentazocine group and least for Tramadol group.In multimodal group, Pentazocine+Piroxicam had longer duration of action compared to Tramadol+Piroxicam group, p<0.0001. As far as the adverse effects were concerned, the addition of Piroxicam to Tramadol and Pentazocine reduced the incidence of side effects compared to individual agents Conclusion:Combining an Opioid and an NSAID, like Tramadol or Pentazocine with Piroxicam, provides better post-operative pain relief than giving an opioid alone.