COMPARISON OF INTRAVENOUS PARACETAMOL VERSUS TRAMADOL FOR POST-OPERATIVE ANALGESIA IN ELECTIVE SURGERIES UNDER GENERAL ANESTHESIA

Abstract

Objectives: The study aimed to compare the analgesic efficacy, hemodynamic effects, rescue analgesic requirements, and adverse-effect profile of intravenous paracetamol and intravenous tramadol for post-operative pain management in patients undergoing elective surgeries under general anesthesia. Methods: This study is a prospective, randomized, assessor-blinded comparative study performed in the Department of Anaesthesiology at a tertiary care teaching hospital from March 2025 to March 2026. A total of 100 adult patients with American Society of Anesthesiologists physical status I-II undergoing elective surgical procedures under general anesthesia were randomly divided into two groups of 50 patients. At the end of surgery, Group P received intravenous paracetamol 1 g, and Group T received intravenous tramadol 100 mg. The Visual Analog Scale (VAS) was used to assess pain at 1, 2, 4, 6, 8, and 12 h post-surgery. Heart rate, mean arterial pressure (MAP), time to first rescue analgesia, total rescue analgesic consumption, and adverse effects were measured and compared between the groups. Results: There were no significant differences in demographic and clinical baseline characteristics between the groups (p>0.05). The paracetamol group had significantly lower VAS scores at 4, 6, and 8 h postoperatively (p≤0.001). Patients treated with paracetamol had a significantly longer time to first rescue analgesia (8.1±1.6 vs. 6.0±1.4 h; p<0.001) and a significantly reduced consumption of diclofenac in the first 12 post-operative h (84±22 vs. 118±28 mg; p<0.001). From 2 h onward, there were significant decreases in heart rate and MAP in the paracetamol group (p<0.05). There were fewer adverse effects in the paracetamol group, and a higher percentage of patients in the paracetamol group reported no adverse effects (90% vs. 74%, p=0.035). Conclusion: Intravenous paracetamol provided superior post-operative analgesia, prolonged analgesic duration, reduced rescue analgesic requirements, and demonstrated a more favorable safety profile compared to intravenous tramadol. It may be considered an effective and safe alternative for post-operative pain management following elective surgeries under general anesthesia.