Post-operative analgesic effect of wound infiltration with bupivacaine versus mixture of bupivacaine and tramadol in caesarean section under spinal anaesthesia: a randomized double-blind interventional controlled study

Background: Caesarean section is among the most frequently performed obstetric surgical procedures worldwide. Effective postoperative analgesia is crucial for promoting maternal comfort and facilitating recovery. Multimodal analgesic approaches are commonly used to optimize pain control, and wound infiltration is considered a simple, safe, and effective technique. This study aimed to assess and compare the postoperative analgesic efficacy of wound infiltration using a combination of bupivacaine and tramadol with that of bupivacaine alone following caesarean delivery. Methods: This prospective, randomised, double-blind trial was conducted at Sawai Man Singh Medical College and Attached Hospitals, Jaipur, India, from February 2021 to [Month 2021] (CTRI/2021/02/031140). Sixty parturients aged 18–35 years, ASA physical status I–II, undergoing caesarean section under spinal anaesthesia were randomised into two groups of 30. Group T received wound infiltration with tramadol 2 mg/kg mixed in 0.25% bupivacaine (total 20 ml), and Group B received 20 ml of 0.25% bupivacaine. The time to first rescue analgesia, Numerical Rating Scale (NRS) pain scores, diclofenac consumption over 24 hours, patient satisfaction and adverse effects were compared. Results: The time to first rescue analgesia was significantly longer in Group T than in Group B (6.60±1.61 vs. 3.21 ±0.65 hours; P<0.001). Total 24-hour diclofenac consumption was significantly lower in Group T (96.67±26.60 vs. 184.00±40.54 mg; mean difference 87.33 mg, 95% CI 69.61–105.05; P<0.001). Patient satisfaction was higher in Group T (P=0.001), and adverse effects were comparable between groups. Conclusions: Subcutaneous wound infiltration with a combination of tramadol and bupivacaine following caesarean section prolongs the pain-free period and reduces postoperative analgesic requirements, thereby enhancing maternal comfort and satisfaction.