Tramadol Versus Ketorolac in the Treatment of Postoperative Pain Following Maxillofacial Surgery

Abstract

Pain plagues daily activity and hence its management would require alleviation at both the mental and physical planes, thus, bringing about comfort. It includes delivering analgesics in parenteral or oral form, or patches depending on the intensity and availability. Best analgesic regimens are ones that offer broad coverage, easy to administer, safe and economical. A drug seemingly appropriate to treat moderate to severe pain would be Tramadol hydrochloride, a centrally acting synthetic opioid analgesic with lower opiate-like dependence than Morphine. Ketorolac, a pyrrolo-pyrrole derivative, possesses analgesic, anti-inflammatory and anti-pyretic activity would also appear equally suitable. Fifty adult ASA grade I and II patients undergoing surgery under GA in the Department of Oral & Maxillofacial Surgery, College of Dental Sciences, Davangere, were included. Ketorolac (30mg IM) for 25 patients and Tramadol (100mg IM) for 25 patients were administered at the time of skin closure and repeated after 8 and 16h from the conclusion of surgery. Pain, using the VAS at the 2nd, 4th, 6th, 12th and 24th post-operative hour, was assessed and compared using χ(2)-test. Vitals were monitored and adverse events were looked for. Though both the drugs resulted in significant decrease in pain intensity from the 2nd to 24th post-operative hour, Tramadol always resulted in better pain control than Ketorolac at every post-operative hour (P<0.050). To conclude, intramuscular Tramadol seemed useful in controlling pain following surgery, with better levels of tolerance than intramuscular Ketorolac. However, both the drugs produced mild side effects but did not appear to influence the outcome.