Abstract
Introduction: Total Abdominal Hysterectomy (TAH) often results in significant postoperative pain due to the invasive nature of the surgery and the involvement of abdominal or pelvic structures. Amongst the myriad pharmacological options available, intravenous IV diclofenac, tramadol, and paracetamol stand out for postoperative pain management due to their distinct mechanisms of action and efficacy profiles.
Aim: To compare the effectiveness of IV diclofenac, IV tramadol, and IV paracetamol in postoperative TAH patients.
Materials and Methods: This prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at Jaipur National University Institute of Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India between September 2023 and November 2024. A total of 150 patients aged 35-55 years who were undergoing elective hysterectomy in the Inpatient Department (IPD) were recruited. Information was collected using a pretested, structured proforma for each patient. The patients were randomly assigned to three groups for postoperative pain management, with 50 patients in each group. Group A was administered IV diclofenac 75 mg eight hourly. Group B was administered IV paracetamol at 1 g 8-hourly. Group C was administered IV tramadol 50 mg in 100 mL NS 8-hourly. Visual Analogue Scale (VAS) was used to assess pain intensity at 6, 12, and 24 hours after surgery. Continuous variables were expressed as mean±standard deviation. Categorical data were expressed as percentages and proportions.
Results: The mean age of patients administered diclofenac was 43.60±4.73 years, with paracetamol was 44.10±4.33 years and with tramadol was 44.22±4.18 years, difference being statistically insignificant. The difference between the three groups was statistically significant (p-value=0.01), with the VAS score being lowest in the paracetamol group than in the other two groups postoperatively. The VAS scores in the IV paracetamol group were 6.26, 4.18, and 1.82 at 6, 12, and 24 hours postoperative, respectively. The VAS score in the IV diclofenac group was 7.14, 5.14, and 3.26 at 6, 12, and 24 hours postoperatively. Whereas the VAS scores in the IV tramadol group were 7.06, 4.22, and 2.14 at 6, 12, and 24 hours postoperatively. The most common side-effects observed were nausea, vomiting, and epigastric pain. Nine patients in the tramadol group had sideeffects compared to seven patients in the diclofenac group and three patients in the paracetamol group. Additional medications were required for 10 patients in the diclofenac group, nine in the tramadol group, and six in the paracetamol group.
Conclusion: The findings of the study indicate that IV paracetamol provided superior pain relief compared with diclofenac and tramadol and was associated with fewer adverse effects.