Tapentadol Versus Tramadol for Preemptive Analgesia in Elective Surgery Under General Anesthesia: A Randomized Controlled Trial

Background: Effective control of postoperative pain is a critical component of perioperative care. Tramadol is commonly used for preemptive analgesia but is associated with variable efficacy and notable side effects. Tapentadol, a newer analgesic with a dual mechanism of action, may offer improved analgesia with fewer side effects. However, comparative data between tapentadol and tramadol in the context of elective surgeries under general anesthesia are limited. Objective: To assess the difference in mean postoperative pain intensity, as quantified by the visual analog scale (VAS), between patients administered tapentadol 75 mg and those administered tramadol 100 mg for preemptive analgesia during elective surgical procedures under general anesthesia. Methods: A randomized controlled trial (RCT) was conducted at the Department of Anesthesia, Jinnah Hospital, Lahore, over six months (September 2, 2023 – March 2, 2024). A total of 60 patients (aged 18–60 years) scheduled for elective surgery under general anesthesia were randomized to receive either tramadol or tapentadol. Patients in Group A (tramadol) received 100 mg of tramadol orally 30 minutes before surgery, while those in Group B (tapentadol) received 75 mg of tapentadol orally 30 minutes before surgery. Standard general anesthesia was administered to all patients. The primary outcome was postoperative pain, assessed using the visual analog scale (VAS) at three hours postoperatively. Secondary outcomes included postoperative nausea and vomiting (PONV) episodes recorded during the three-hour observation period. Patients with known allergies to opioids, chronic pain conditions, or a history of substance abuse were excluded. Randomization was performed using a lottery method. Data were analyzed using appropriate statistical tests. Results: The mean age of patients was 44.30 ± 4.57 years in the tramadol group and 42.46 ± 5.07 years in the tapentadol group (p = 0.147), while the mean BMI was 28.13 ± 12.33 kg/m² and 25.79 ± 3.80 kg/m², respectively (p = 0.192), with no statistically significant difference between the groups. The mean postoperative pain score was significantly lower in the tapentadol group (1.96 ± 0.18) compared to the tramadol group (3.16 ± 0.37) (p < 0.001). Gender distribution showed that in the tramadol group, 65.4% (n = 17) were male and 38.2% (n = 13) were female, while in the tapentadol group, 34.6% (n = 9) were male and 61.8% (n = 21) were female (p = 0.067), indicating a tendency toward a higher female population in the tapentadol group. Regarding postoperative nausea and vomiting (PONV), although not statistically significant, there was a trend toward fewer episodes in the tapentadol group; however, a quantitative measurement of this metric was absent from the abstract. Conclusion: This study concludes that tapentadol 75 mg is a more effective preemptive analgesic than tramadol 100 mg in reducing postoperative pain scores in patients undergoing elective surgery under general anesthesia. Further research is warranted to investigate the optimal dosing and long-term effects of tapentadol in this setting and to perform a more rigorous assessment of PONV between the two drugs.