Influence of pre-operative infiltration of local anesthetics bupivacaine vs lignocaine vs tramadol on postoperative pain control following lichtenstein mesh hernioplasty.

Abstract

Objective: To evaluate the influence of pre-operative infiltration of local anesthetics bupivacaine V/S Lignocaine V/S Tramadol on postoperative analgesic pain control following Lichtenstein mesh hernioplasty. Study Design: Quasi-experimental Trial. Setting: Surgical Department, Ittefaq Hospital, Lahore. Period: Over four months, with an additional month for statistical analysis from March 2023 to July 2023. Methods: Ninety patients aged 18–65 years undergoing elective Lichtenstein mesh hernioplasty were randomized into three groups: Group A received tramadol 2 mg/kg, Group B received 0.25% bupivacaine, and Group C received 2% lignocaine for pre-operative local infiltration. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 2, 4, 6, 12, and 24 hours. The primary outcome was the duration of postoperative analgesia, defined as the time from completion of surgery to the first request for additional analgesia. Results: The tramadol group exhibited a significantly longer pain-free duration (12.25 ± 1.99 hours) compared to the bupivacaine (4.88 ± 1.30 hours) and lignocaine (3.81 ± 1.04 hours) groups (p < 0.001). VAS pain scores at all time points were consistently lower in the tramadol group. For instance, at 2 hours postoperatively, the VAS score was 2.09 ± 0.79 in the tramadol group, 3.68 ± 0.96 in the bupivacaine group, and 3.99 ± 1.26 in the lignocaine group (p < 0.001). No significant differences in adverse effects were observed among the groups. Conclusion: Pre-operative local infiltration with tramadol provides superior and prolonged postoperative analgesia compared to bupivacaine and lignocaine in inguinal hernia repair. Tramadol's cost-effectiveness and favorable safety profile make it a viable option for postoperative pain management, especially in resource-constrained settings.