Tramadol 75mg / Paracetamol 650mg tablets

BackgroundInadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects.ObjectiveTo identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy.Databases and data treatmentThis systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with Trial Sequential Analysis (TSA) to adjust for random errors. Risk of bias was assessed using ROB2, and certainty of evidence was evaluated with GRADE.ResultsA total of 76 RCTs comprising 5617 participants were included, covering 11 analgesic strategies. Paracetamol, NSAIDs, epidural and intrathecal anaesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid consumption. Several interventions-including paracetamol, NSAIDs, glucocorticoids, ketamine, epidural and intrathecal anaesthetics, local anaesthetics, nerve blocks, gabapentin, and pregabalin-were also associated with lower pain scores at 6 and 24 h. However, evidence certainty ranged from low to very low due to methodological limitations, small sample sizes, heterogeneity, and inconsistent baseline analgesia.ConclusionsMultiple analgesic strategies show potential for reducing opioid use and improving early postoperative pain control after lumbar discectomy. Nevertheless, the low certainty of evidence highlights the urgent need for high-quality, standardized trials to inform clinical practice.SignificanceThe findings demonstrate that the following analgesics significantly reduce supplemental opioid consumption and pain levels in the immediate postoperative period: PCM, NSAIDs, intrathecal anaesthetics, epidural anaesthetics, LIA/wound infiltration, nerve blockade, gabapentin, and pregabalin. However, the high risk of bias and low quality of evidence in many of the included trials necessitate cautious interpretation of the findings.

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Introduction Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgical procedure that can result in significant postoperative discomfort. Pain following this surgery has both somatic and visceral components. Providing adequate pain relief after the procedure is essential to enable early ambulation, which is crucial for patient satisfaction and facilitating timely discharge. The application of ultrasound (US) in anesthetic practice has initiated a new era of US-guided blocks for postoperative analgesia, replacing traditional methods. This study was planned to evaluate the analgesic efficacy of US-guided erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane (OSTAP) block in patients undergoing elective LC, to compare the analgesic requirements in both groups, and to compare the numeric rating scale (NRS) scores in both groups. Materials and methods Sixty patients aged between 18 and 75 years, with American Society of Anesthesiology (ASA) Grades I and II, were enrolled in the study. They were randomized into two groups: one group that received a bilateral ESPB (Group E) at the T7 level and another that received a bilateral OSTAP block (Group O) with 20 mL of 0.375% bupivacaine, following intubation. The primary outcomes measured were the median NRS scores and the time to first analgesic requirement during the first 24 hours postoperatively. Secondary outcomes included total tramadol consumption, analgesic requirements, and complications related to the opioids or blocks. Results The ESPB group reported an NRS score < 4 up to 12 hours postoperatively. The NRS scores in Group E were significantly lower at 20 minutes, 40 minutes, 1 hour, 3 hours, 6 hours, and 12 hours post-surgery when compared to Group O (p < 0.05). The mean time to first rescue analgesic requirement was 12.2 ± 5.6 hours in Group E and 6.6 ± 2.84 hours in Group O, which was found to be statistically significant (p < 0.001). The total tramadol consumption per patient in 24 hours was significantly higher in Group O than in Group E (p < 0.001). Conclusion Bilateral US-guided ESPB provides effective analgesia, resulting in lower pain scores and reduced postoperative tramadol consumption within the first 12 hours for patients undergoing LC.

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Abstract Background Effective postoperative pain management in pediatric patients is essential for recovery, though no single analgesic is considered superior. Nalbuphine and tramadol are common alternatives to traditional opioids, each with a distinct pharmacological profile. This study compares the efficacy and safety of nalbuphine versus tramadol in managing postoperative pain after abdominal surgery in pediatric cancer patients. Methods This prospective, randomized clinical trial involved 128 children with cancers (3–12 years) undergoing elective abdominal surgery. Patients were randomized into two groups: the Nalbuphine group (0.2 mg/kg IV every 8 hours) and the Tramadol group (2 mg/kg IV every 8 hours) for 72 hours postoperatively. Pain was assessed using the Wong-Baker FACES Pain Scale (WB), and rescue analgesia with paracetamol was provided as needed. The primary outcome measure was the time to first rescue analgesia, while secondary outcomes included pain scores, paracetamol consumption, and adverse effects. Results Nalbuphine provided superior pain relief during the first 24 hours postoperatively, with significantly lower WB scores compared to tramadol. However, tramadol demonstrated complete pain resolution by 48–72 hours, while some nalbuphine patients reported mild pain. The need for rescue analgesia was low and comparable between groups (9.4% vs. 7.8%, p = 0.752). Both drugs maintained hemodynamic stability and had similar safety profiles, with minimal adverse effects. Conclusion Nalbuphine offers better early postoperative pain control, while tramadol provides more sustained analgesia beyond 24 hours. Both drugs are effective and safe. Trial registration: this study was retrospectively registered at clinical trial gov. (ID: NCT07110051), URL: https://clinicaltrials.gov/study/NCT07110051?cond=NCT07110051&rank=1, Date: 31/07/2025.

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There are many management strategies and interventions both preoperative, intraoperative, and postoperative  that can be carried out in dealing with postoperative pain. Guidelines for pain management have been prepared  by the American Pain Society (APS) with recommendations from  the American Society of Anesthesiologists (ASA) where there are many recommendations in postoperative pain management in adults or children by promoting the provision of preoperative education, the use of various modalities both pharmacological and non-pharmacological to the establishment of pain management procedures or policies in each institution. For this reason, the author was interested in examining the comparison of the effectiveness of analgesia between intravenous tramadol and intravenous Paracetamol in minimally invasive Percutaneous Nephrolithotomy (PCNL) postoperative patients at RSUP Dr. M. Djamil Padang. The research was a prospective study with a single-blind randomised controlled trial design. The data used were sourced from clinical trials conducted on post-PCNL patients divided into two subgroups given intravenous tramadol analgetics and others given Paracetamol tablets. In this study, the incidence of Nephrolithiasis was obtained, which was dominated by the male sex, compared to women and suffered a lot at the age of 41-60 years. There was a significant difference in VAS effectiveness between the use of Paracetamol IV and Tramadol IV in post-PCNL patients. The use of Paracetamol may be considered to replace tramadol in the disappearance of acute pain after PCNL postoperative patients in those patients who are allergic to tramadol.

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We appreciate the opportunity to respond to the thoughtful comments regarding our randomized controlled trial that compared the continuous pericapsular nerve group block and the continuous supra-inguinal fascia iliaca compartment block techniques for postoperative pain management following total hip arthroplasty. Both groups in our study were demographically comparable. All participants underwent elective, unilateral, primary total hip arthroplasty and were classified as American Society of Anesthesiologists physical status I or II. Randomization was performed using a computer-generated sequence with allocation concealment, minimizing the risk of selection bias. In terms of analgesic protocol, every patient received scheduled intravenous administration of the non-steroidal anti-inflammatory drug ibuprofen and patient-controlled analgesia with tramadol. Intravenous paracetamol was administered only as a rescue medication when the visual analog scale pain score exceeded four. Although several guidelines, such as the enhanced recovery after surgery and the procedure-specific postoperative pain management guidelines published by the European Society of Regional Anaesthesia, recommend routine scheduled use of paracetamol along with nonsteroidal anti-inflammatory drugs, both groups in our study followed the same analgesic regimen. This uniformity supports the internal validity of our comparative results. We observed that the group receiving the pericapsular nerve group block showed a continuous decline in pain scores, while the fascia iliaca compartment block group experienced increasing pain after six hours. Although the difference in opioid use was slightly below the minimal clinically important difference, it was accompanied by lower pain scores and less need for rescue medication. We acknowledge the absence of patient-reported outcomes as a limitation and encourage their inclusion in future research.

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