Efficacy of Epidural Ropivacaine Alone Versus Ropivacaine PlusTramadol for Postoperative Pain Control in Adult Abdominal SurgeryPatients

Background: Effective postoperative pain management is crucial to enhance recovery and reduce morbidity fol-lowing major abdominal surgeries. Epidural administration of local anesthetics such as ropivacaine provides seg-mental analgesia, but may be insufficient for optimal pain control in some patients. Tramadol, a weak μ-opioidreceptor agonist with monoaminergic properties, has been shown to augment analgesia when delivered epidurally.This study aims to compare the analgesic efficacy and safety profile of epidural ropivacaine alone versus ropiva-caine combined with tramadol in adult patients undergoing elective abdominal surgeries under general anaesthe-sia.Methods: In this prospective, randomized, double-blind trial, 80 adult patients (ASA I–II), aged 18–65 years,scheduled for elective lower abdominal surgery under general anaesthesia with epidural analgesia, were enrolled.Patients were randomly assigned to one of two groups (n=40 each):• Group R received epidural ropivacaine 0.2% at 6 mL/hour• Group RT received ropivacaine 0.2% with tramadol 1 mg/mL at the same infusion rateGeneral anaesthesia protocols were standardized across both groups. Postoperative pain intensity was assessedusing a 10-point visual analogue scale (VAS) at 2, 4, 8, 12, 24, and 48 hours. Rescue analgesia (intravenousmorphine 2 mg) was administered for VAS > 4, and cumulative morphine consumption was recorded. Hemody-namic parameters, sedation scores, and adverse events (nausea, vomiting, pruritus, respiratory depression) weremonitored throughout the 48-hour postoperative period.Results: Both groups were comparable in demographic and intraoperative variables. Group RT demonstratedsignificantly lower mean VAS scores at all time points beyond 4 hours postoperatively (p < 0.05). The total mor-phine requirement in the first 48 hours was reduced by 35% in Group RT compared to Group R (mean ± SD: 8.2± 2.4 mg vs. 12.6 ± 3.1 mg; p < 0.001). Hemodynamic stability was maintained in both groups, with no clinicallysignificant differences. Incidence of nausea and vomiting was slightly higher in Group RT (15% vs. 8%), thoughnot statistically significant. No cases of respiratory depression or pruritus were observed.Conclusions: Adding tramadol to epidural ropivacaine significantly enhances postoperative analgesia and reducesopioid requirements in adult patients following abdominal surgery, without compromising hemodynamic stability.This combination may be considered an effective and safe option for postoperative pain management in thispopulation.