Key result
Local tramadol via transversus abdominis plane block significantly reduced immediate postoperative resting pain compared to preemptive intravenous tramadol (VAS 4.3 vs 6.1, p=0.031).
Why the study?
Mismanaged acute postoperative pain increases morbidity and mortality, and tramadol demonstrates both systemic and local anesthetic properties that may provide effective perioperative analgesia in abdominal surgery.
Does local infiltration tramadol via TAP block reduce postoperative pain compared to preemptive intravenous tramadol in patients undergoing open appendectomy?
RCT (n=32)
Double-blind
Randomized
No
Does local infiltration tramadol via TAP block reduce postoperative pain compared to preemptive intravenous tramadol in patients undergoing open appendectomy?
Mean Difference: -1.8
Absolute Event Rate: 4.3% vs 6.1%
p-value: p=0.031
Local tramadol infiltration via transversus abdominis plane block provides superior immediate postoperative pain relief compared to preemptive intravenous tramadol in patients undergoing open appendectomy.
Supports tramadol TAP for immediate postop pain after open appendectomy; confirms local efficacy but leaves opioid-sparing and broader use open.
Background: Acute postoperative pain, if mismanaged, leads to increased morbidity and mortality. Effective perioperative analgesia is crucial to prevent persistent pain. In abdominal surgeries, endogenous opioids are released, and tramadol, a weak synthetic opioid, has demonstrated effective analgesic properties. Recent studies suggest tramadol's mechanism involves blocking voltage-dependent sodium channels, which increases extracellular calcium and affects peripheral nerves. This suggests tramadol has both systemic and local anesthetic effects. Methods: A prospective, randomized, double-blind study was conducted on 32 patients (ages 18–60) diagnosed with acute appendicitis who underwent open appendectomy under general anesthesia. Participants were randomly assigned to two groups: group 1 received normal saline with tramadol infiltration for transversus abdominis plane (TAP) block (n=16), and group 2 received preemptive intravenous tramadol with TAP normal saline infiltration (n=16). Pain was assessed using the visual analogue scale (VAS) at various postoperative intervals. Opioid consumption was monitored through patient-controlled analgesia (PCA), and intraoperative data, complications, and hospital stay were recorded. Results: Demographic data were similar between groups. The primary outcome showed a significant reduction in postoperative pain (VAS score) at 0 hours (p=0.031) for the tramadol TAP group, with a 1-point reduction in pain over 24 hours compared to the intravenous group. Secondary outcomes indicated reduced opioid consumption, with no significant differences in complications (nausea/vomiting, infection, hospital stay). Conclusions: Local tramadol combined with TAP block is an effective alternative for postoperative pain relief after open appendectomy, reducing opioid consumption without additional complications.
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Kitudomrat et al. (2025) conducted an RCT in Acute appendicitis (n=32). Local infiltration tramadol (transversus abdominis plane block) vs. Preemptive intravenous tramadol (1 mg/kg) was evaluated on Immediate postoperative resting pain (VAS score) (MD -1.8, p=0.031). Local tramadol via transversus abdominis plane block significantly reduced immediate postoperative resting pain compared to preemptive intravenous tramadol (VAS 4.3 vs 6.1, p=0.031).
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