Comparative Study of Intravenous Diclofenac and Tramadol Effect on Postoperative Pain Relief and Reduced Side Effects in Patients Undergoing Laparoscopic Cholecystectomy

Laparoscopic management of diseases is nowadays accepted in the international community and can be considered as one of the most common methods of abdominal surgery and standard treatment of gallstone as well as Cholecystitis. However, postoperative pain, one of the most common causes of delayed release after surgery, is a complex, multifactorial experience and an unpleasant sensory and emotional experience that is still one of the most serious problems for physicians and patients undergoing surgery that should be managed with injection of proper drugs to impose the least side effects possible on patients. The purpose of this study was to compare diclofenac and tramadol effect on postoperative pain relief and reduced side effects in patients undergoing laparoscopic cholecystectomy.

This is a randomized double blind clinical trial study. In this study, 61 patients who were Laparoscopic Cholecystectomy candidates were randomly divided into two groups of 31 and 30. The first group received 75 mg/kg diclofenac (N = 31) and the second one 100 mg/kg tramadol
(N = 30) as intravenous injection every 6 hours. Postoperative pain assessment was performed using VAS (Visual Analogue Scale) System at 6, 12, 18, 24 hours and their pain was evaluated. In case of pain, patients were given meperidine and finally dosage of meperidine was measured and recorded. After collection, data were encoded and entered into SPSS 18 software. Then, the data were analyzed using analytical statistical methods such as T-test and Chi-square. Significance level was set below 0.05.

24 hours after laparoscopic cholecystectomy, the mean prevalence of nausea in the diclofenac recipient group was significantly lower than the tramadol recipient group (P = 0.013). The mean prevalence of vomiting in the diclofenac group was significantly lower than that of the tramadol group
(P = 0.011). The mean prevalence of gastritis in the tramadol recipient group was significantly lower than the diclofenac recipient group (P = 0.006). Mean pain intensity in the tramadol group was significantly lower than the diclofenac group (P = 0.010). There was no other statistically significant difference between the two groups.

The pain after laparoscopic cholecystectomy is a common one that can be managed with injection of proper drugs to impose the least side effects possible on patients. The gold standard in postoperative pain management is the use of opiate medications; however, its use is limited due to side effects. Therefore, the present study concludes that intravenous tramadol is a more effective option than diclofenac for pain relief and will lead to a more comfortable postoperative period. However, it is worth noting that tramadol has a higher incidence of side effects than diclofenac, necessitating the opinion of attending physician for the injection of this drug according to patients’ condition.