Adding Paracetamol to Tramadol to Relieve Early Postoperative Pain After Lumbar Discectomy
A recently published study is likely the first prospective randomized controlled trial comparing the postoperative analgesic efficacy of a tramadol and paracetamol combination versus tramadol alone. Its results favor the combination, with significantly lower pain scores during the first 30 minutes and reduced tramadol consumption within the first 24 hours post-surgery.
Methodology and Study Progress
Sixty patients aged 18–60 years who underwent lumbar discectomy were included in the study. After randomization at a 1:1 ratio, they received either tramadol alone at a dose of 1 mg/kg i.v. or a combination of tramadol 1 mg/kg i.v. with paracetamol 1 g i.v. 30 minutes before the end of the surgery and anesthesia. Administration of paracetamol (1 g) continued at 6-hour intervals for the first 24 hours post-surgery. If the pain score on a 10-point numerical rating scale (NRS; 10 points = maximum imaginable pain) exceeded 3 and it was necessary, patients received tramadol, titrated to a maximum dose of 0.1 mg/kg i.v.
Pain scores (according to NRS), nausea and vomiting severity scores (NSS/VSS with values 0–2; 0 = no nausea/vomiting), and patient satisfaction scores (PSS with values 0–3; 3 = maximum satisfaction) were evaluated at 5, 15, 20, and 30 minutes and 1, 2, 4, 6, 12, and 24 hours post-surgery.
The primary parameter was the difference in the total dose of tramadol administered during the first 24 hours post-surgery.
Results
Patient demographics, duration of surgery, and anesthesia were comparable in both groups.
The total average dose of tramadol during the first 24 hours post-surgery was significantly lower in the group that received the tramadol + paracetamol combination (81.20 vs. 106.12 mg; p = 0.04).
Pain scores were significantly lower at 5, 15, 20, and 30 minutes post-surgery in the group receiving the combined analgesic treatment compared to the tramadol group alone (p = 0.021, p = 0.004, p = 0.002, p = 0.018). In subsequent measurements (1–24 hours post-surgery), pain scores were comparable in both groups.
A significant difference in PSS scores between the groups was observed at 20 minutes post-surgery, with greater satisfaction among patients who were given the tramadol + paracetamol combination.
The incidence of adverse events (pruritus, nausea, vomiting) was comparable between the groups.
Conclusion
The presented study builds on previous work suggesting a reduced consumption of opioids in the postoperative period when paracetamol is administered. It demonstrated that paracetamol in combination with tramadol is more effective in relieving early postoperative pain in adult patients undergoing lumbar discectomy. The benefit of paracetamol was not apparent in the later postoperative period in this study, but the combined treatment significantly reduced the total dose of tramadol administered as needed during the first 24 hours post-surgery.
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Source: Uztüre N., Türe H., Keskin Ö. et al. Comparison of tramadol versus tramadol with paracetamol for efficacy of postoperative pain management in lumbar discectomy: a randomised controlled study. Int J Clin Pract 2020; 74 (1): e13414, doi: 10.1111/ijcp.13414.
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