Comparison effect of local subcutaneous tramadol and methadone in post laparotomy pain control

Abstract

Objective: Postoperative pain management is an important part of surgical care. It is commonly known that methadone and tramadol are often administered for pain relief after surgery. In this study, we evaluated the effects of a subcutaneous injection of methadone and tramadol before carrying out a skin suture for postoperative pain following laparotomy. Materials and Methods: In this double‐blinded randomized clinical trial, 60 patients who underwent major abdominal surgery were randomly allocated into either subcutaneous methadone or tramadol groups. Tramadol 1.5 mg/kg or methadone 70 μg/kg, both diluted with normal saline to 10 cc, were injected subcutaneously around the patient’s incision site. The patient’s pain severity was measured every 1, 6, 12, 18, and 24 hours after surgery using a visual analog scale (VAS). Pethidine was injected if the patient requested further pain relief. The administered pethidine doses and pain VAS scores were compared between the two groups. Results: There was no significant difference observed in the duration of hospital stay post surgery between the tramadol and methadone groups. Both drugs were effective in relieving pain in the first 12 hours with no significant difference between groups; afterwards, the pain was aggravated. However, the VAS score was significantly lower in the tramadol group at 18 (3.13±0.93 vs. 4.30±0.95, p<0.001) and 24 hours (3.93±0.86 vs. 5.00±1.25, p<0.001). The tramadol group required a significantly lower dose of pethidine (214.01±23.12 mg vs. 243.3±36.72 mg, p=0.01) than the methadone group. Conclusion: Subcutaneous administration of tramadol and methadone was effective in relieving pain in the first 12 hours post surgery, but afterwards, the need for analgesics were increased. The study concluded that tramadol may be more effective than methadone for pain relief in the first day after surgery.