COMPARISON OF EPIDURAL TRAMADOL AND EPIDURAL FENTANYL FOR POSTOPERATIVE PAIN AND HEMODYNAMIC CHANGES: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Effective postoperative pain control improves recovery and patient satisfaction. Epidural analgesia is commonly used for this purpose, with fentanyl being a widely accepted opioid additive. However,Tramadol, with its mixed opioid and monoaminergic action, is a potential alternative with fewer respiratory side effects [1,2,3].

Objective: To compare the analgesic efficacy and hemodynamic stability of epidural tramadol versus epidural fentanyl in postoperative patients undergoing lower abdominal surgeries.

Methods: In this prospective randomized controlled study, 60 patients aged 18–60 years, ASA physical status I–II, undergoing elective lower abdominal surgery under general anesthesia were randomized into two groups (n = 30 each). Group T received 50 mg epidural tramadol diluted to 10 mL with normal saline. Group F received 50 mcg epidural fentanyl diluted to 10 mL. Pain was assessed using the Visual Analogue Scale (VAS) at 0, 15, 30, 60, 120, and 240 minutes postoperatively. Hemodynamic parameters (HR, MAP) and side effects were recorded.

Results: Both groups achieved effective analgesia (VAS ≤ 3). Group F had a faster onset of analgesia (15.4 ± 2.3 min vs. 18.1 ± 2.7 min, p < 0.05), while Group T showed longer-lasting pain relief (VAS scores were lower at 240 minutes). Hemodynamic parameters remained stable in both groups, though Group F showed a transient decrease in HR and MAP at 30 minutes. Nausea and vomiting were more common in the tramadol group; pruritus was more frequent in the fentanyl group.

Conclusion: Epidural tramadol and fentanyl both offer effective postoperative analgesia. Fentanyl provides a quicker onset, whereas tramadol offers prolonged analgesia with minimal hemodynamic disturbance. Tramadol is a viable alternative in patients at risk of opioid-related side effects.