Analgesic Effectiveness of Wound Infiltration with Bupivacaine versus a Mixture of Bupivacaine with Tramadol for Postoperative Pain Management among Parturients Undergoing Elective Cesarean Section under Spinal Anesthesia, 2024: A Double-Blind Randomized

Abstract Background: Post-cesarean pain is among the major problems with an incidence of 25.5 to 80%. Despite its simplicity, the effectiveness of wound infiltration with a mixture of bupivacaine and tramadol is still unknown. Therefore this study aims to compare the analgesic effectiveness of wound infiltration with bupivacaine versus a combination of bupivacaine with tramadol for postoperative pain management among parturients undergoing cesarean section under spinal anesthesia. Methodology: A double-blind, parallel, randomized controlled trial was conducted on 60 parturients. Parturients were randomized to take either bupivacaine (B=30) or a combination of bupivacaine and tramadol (BT=30). The homogeneity of variance was assessed using Levine's test, and the normality was assessed using Shapiro-Wilk. The independent t-test and the Manny Whitney U test were used, respectively, for Parametric and non-parametric data. A mixed linear model and general estimating equations were used to assess repeated measurements. Result: Totally 60 parturients were analyzed and no dropouts. The severity of pain at the 6th hour is 6 times greater in the B group in comparison to the BT Group (P= 0.001, OR=6.289, CI=2.097-18.858). The mean tramadol consumption was lesser in the BT group (140.00+48.066 mg) than B group (175.00+34.114 mg) min with a statistically significant mean difference of 10.761 (95% CI, 13.459 to 56.541), t (58) = 3.252, P= 0.002, (d=0.839). The mean first analgesia request was higher in a mixture of the BT group, (367.33+50.099 min) than B group (216.33+68.744 min) with a statistically significant difference of 15.530 (95% CI, -182.087 to -119.913), t (58) = 5.6553, P= 0.001. Conclusion: Wound infiltration with a combination of bupivacaine and tramadol is more effective than bupivacaine alone for postoperative analgesia for pregnant patients who underwent cesarean section under spinal anesthesia.