COMPARISON OF COMPARISON OF RECTALRECTAL TRAMADOLTRAMADOL WITH WITH

DICLOFENACDICLOFENAC FOR PROVIDING FOR PROVIDING POST OP ANALGESIA IN POST OP ANALGESIA IN CAESAREAN SECTIONSCAESAREAN SECTIONS

DR.O.SUGANYA MANOHARAN DR.O.SUGANYA MANOHARAN CO AUTHORSCO AUTHORS

PROF.DR.R SELVAKUMARPROF.DR.R SELVAKUMARPROF.DR.B.CHANDRIKAPROF.DR.B.CHANDRIKA

PROF.DR.A.CHANDRASEKARANPROF.DR.A.CHANDRASEKARANCOIMBATORE MEDICAL COLLEGE,CBE.COIMBATORE MEDICAL COLLEGE,CBE.

INTRODUCTIONINTRODUCTION

*MODALITIES OF POSTOPERATIVE *MODALITIES OF POSTOPERATIVE ANALGESIA ARE MANY.ANALGESIA ARE MANY.

*RECTAL ROUTE IS ONE AMONG THEM *RECTAL ROUTE IS ONE AMONG THEM AND IT IS EASIER AND MORE PATIENT AND IT IS EASIER AND MORE PATIENT COMPATIBLE.COMPATIBLE.

*TRAMADOL IS THE RECENT ENTRY IN *TRAMADOL IS THE RECENT ENTRY IN SUPPOSITORY FORM.SUPPOSITORY FORM.

AIMAIM

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

MATERIALS & METHODSMATERIALS & METHODS

DOUBLE BLINDED PROSPECTIVE DOUBLE BLINDED PROSPECTIVE STUDYSTUDY

2 GROUPS OF 20 PTS EACH 2 GROUPS OF 20 PTS EACH UNDERGOING LSCS UNDER SPINAL UNDERGOING LSCS UNDER SPINAL ANAESTHESIA ARE SELECTEDANAESTHESIA ARE SELECTED

TO RECEIVE EITHER RECTAL TO RECEIVE EITHER RECTAL TRAMADOL 100MG OR DICLOFENAC TRAMADOL 100MG OR DICLOFENAC 100MG POST OPERATIVELY.100MG POST OPERATIVELY.

OBSERVATIONOBSERVATIONDEMOGRAPHIC PROFILEDEMOGRAPHIC PROFILETRAMADOL TRAMADOL GROUPGROUP

DICLO DICLO GROUPGROUP

SIGNIFICANCESIGNIFICANCE

AGEAGE 25.1±2.925.1±2.9

24.3±3.124.3±3.1 P >0.05P >0.05

NOT NOT SIGNIFICANTSIGNIFICANT

HEIGHTHEIGHT 154.5±5.02154.5±5.02 152.2±4.152.2±4.4343

P >0.05P >0.05

NOT NOT SIGNIFICANTSIGNIFICANT

WEIGHTWEIGHT 55.35±4.155.35±4.1 53.55±5.53.55±5.22

P >0.05P >0.05

NOT NOT SIGNIFICANTSIGNIFICANT

OBSERVATIONOBSERVATION

DURATION OF ANALGESIA WITH VAS DURATION OF ANALGESIA WITH VAS LESS THEN 4LESS THEN 4

TRAMADOL TRAMADOL GROUP GROUP mean±SDmean±SD

(mins)(mins)

DICLOFENAC DICLOFENAC GROUPGROUP

mean±SDmean±SD

(mins)(mins)

SIGNIFICANCESIGNIFICANCE

297±65.64297±65.64 170.5±58.4170.5±58.4 P <0.05P <0.05

SIGNIFICANTLYSIGNIFICANTLY

HIGHERHIGHER

OBSERVATION OBSERVATION

DURATION OF ANALGESIA WITH VAS DURATION OF ANALGESIA WITH VAS >4 TILL THE PTS REQUIRE RESCUE >4 TILL THE PTS REQUIRE RESCUE ANALGESIAANALGESIA

TRAMADOL TRAMADOL GROUPGROUP

mean±SD(minmean±SD(mins)s)

DICLOFENAC DICLOFENAC GROUPGROUP

mean±SD(mimean±SD(mins)ns)

SIGNIFICANCESIGNIFICANCE

363±94363±94 221.5±75.43221.5±75.43 P <0.05P <0.05

SIGNIFICANTLYSIGNIFICANTLY

HIGHERHIGHER

SIDE EFFECTSSIDE EFFECTS

TRAMADOL TRAMADOL GROUPGROUP

DICLOFENAC DICLOFENAC GROUPGROUP

NAUSEANAUSEA 45%45% 50%50%

VOMITINGVOMITING 25%25% 35%35%

EXPULSIONEXPULSION 5%5% 5%5%

DISCUSSIONDISCUSSION

BRIEF PHARMACOLOGYBRIEF PHARMACOLOGY TRAMADOLTRAMADOL –SYNTHETIC 4-PHENYL PIPERIDINE –SYNTHETIC 4-PHENYL PIPERIDINE

ANALOGUE OF CODEINE,ANALOGUE OF CODEINE, METABOLIZED BY DEMETHYLATION IN LIVER AND METABOLIZED BY DEMETHYLATION IN LIVER AND

EXCRETED THROUGH KIDNEY,EXCRETED THROUGH KIDNEY, IT INHIBITS NA & SERATONIN REUPTAKE AT NERVE IT INHIBITS NA & SERATONIN REUPTAKE AT NERVE

TERMINALS THUS ACTIVATING MONOAMINERGIC SPINAL TERMINALS THUS ACTIVATING MONOAMINERGIC SPINAL INHIBITION OF PAIN,INHIBITION OF PAIN,

DICLOFENAC- DICLOFENAC- NSAID.NSAID. ARYL ACETIC ACID DERIVATIVE.ARYL ACETIC ACID DERIVATIVE. INHIBITS CYCLO OXYGENASE ENZYME.INHIBITS CYCLO OXYGENASE ENZYME. INHIBITS PG SYNTHESIS & HAVE ANTI-PLATELET ACTION.INHIBITS PG SYNTHESIS & HAVE ANTI-PLATELET ACTION.

REVIEW OF LITERATUREREVIEW OF LITERATURE

EFFECT OF RECTAL DICLOFENAC IN EFFECT OF RECTAL DICLOFENAC IN REDUCING POST OP PAIN AND RESCUE REDUCING POST OP PAIN AND RESCUE ANALGESIA AFTER CARDIAC SURGERIES-ANALGESIA AFTER CARDIAC SURGERIES-DHAWAN,KIRAN,CARDIOTHORACIC DHAWAN,KIRAN,CARDIOTHORACIC CENTRE, AIIMS,NEW DELHI.CENTRE, AIIMS,NEW DELHI.

OPIOD SPARING EFFECT OF RECTAL OPIOD SPARING EFFECT OF RECTAL DICLOFENAC FOLLOWING TOTAL DICLOFENAC FOLLOWING TOTAL ABDOMINAL HYSTERECTOMY BENEFITS ABDOMINAL HYSTERECTOMY BENEFITS THE PATIENTS BY DR.J.ANAES,2002.THE PATIENTS BY DR.J.ANAES,2002.

REVIEW OF LITERATUREREVIEW OF LITERATURE

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

SUMMARYSUMMARY

40 PATIENTS UNDERGOING LSCS ARE 40 PATIENTS UNDERGOING LSCS ARE SELECTED,20 PATIENTS RECEIVE RECTAL SELECTED,20 PATIENTS RECEIVE RECTAL TRAMADOL,20 PATIENTS RECEIVE RECTAL TRAMADOL,20 PATIENTS RECEIVE RECTAL DICLOFENAC.DICLOFENAC.

TRMADOL SUPPOSITORY HAD A PAIN FREE TRMADOL SUPPOSITORY HAD A PAIN FREE PERIOD OF PERIOD OF 297 MINS(±65.6)297 MINS(±65.6) COMPARED COMPARED WITH DICLOFENAC HAVING A PAIN FREE WITH DICLOFENAC HAVING A PAIN FREE PERIOD OF PERIOD OF 170.5 MINS(±58.5).170.5 MINS(±58.5).

SUMMARYSUMMARY

DURATION OF ANALGESIA TILL THE DURATION OF ANALGESIA TILL THE PTS REQUIRING RESCUE ANALGESIA PTS REQUIRING RESCUE ANALGESIA WITH TRAMADOL IS WITH TRAMADOL IS 363MINS(±94)363MINS(±94) WHILE FOR DICLOFENAC WHILE FOR DICLOFENAC 221.5MINS(±75.4).221.5MINS(±75.4).

SIDE EFFECTS EQUAL FOR BOTH SIDE EFFECTS EQUAL FOR BOTH GROUPS.GROUPS.

CONCLUSIONCONCLUSION

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

THANK YOUTHANK YOU