Post Operative Pain Control in Inguinal Hernia Repair: Comparison of Tramadol Versus Bupivacaine in Local Wound Infiltration: A Randomized Controlled Trial

Background: Post-operative pain control is a key factor in surgery. It greatly increases patient satisfaction, and influences the hospital stay period. Local wound infiltration has often been used to control postoperative pain following hernia surgery, with the use of the conventional local anesthetics like Lidocaine or Bupivacaine. The use of Tramadol for local wound infiltration is new and not yet practised in Rwanda. The aim of this study was to compare the postoperative pain control effects and cost effectiveness of Tramadol versus Bupivaaine in wound infiltration following inguinal hernia repair. Methods: This was a randomized controlled trial conducted between September 2015 and February 2016. Randomization was done using a sealed envelope containing the name of drug to be used for local wound infiltrations following inguinal hernia repair. Results: A total of 52 patients were enrolled equally in the two study groups. Only one female patient enrolled in the study. Tramadol was found to be superior to Bupivacaine in providing postoperative pain control. ( P =0.000). Pain free period was 4.7±1.3 hours in Bupivacaine group while it twas more than 12 hours in Tramadol group. Additional analgesia request in both groups was significantly different, in favor of Tramadol. ( P =0.000). No complications reported in both groups. Bupivacaine was found to be 5 times more expensive than Tramadol. Conclusion: Wound infiltration with Tramadol after open inguinal hernia repair offers a superior and prolonged pain control compared to Bupivacaine. The need of additional analgesics is very low after Tramadol wound infiltration compared to Bupivacaine used in the same conditions. In addition, Tramadol is cheaper making its use cost affordable Keywords: Postoperative pain, Wound infiltration, Tramadol, Bupivacaine/ macaine