Md. Abul Hasnat1, Mohammad Zahirul Islam2, Suhel Ahmed3, Benojir Waquar4
1. Assistant Professor, Department of Anesthesiology, Jalalabad Ragib Rabeya Medical College & Hospital, Sylhet.
2. R/S Sylhet MAG Osmani Medical College Hospital, Sylhet.
3. Junior Consultant, Sunamganj Sadar Hospital, Sylhet.
4. Indoor Medical Officer, Department of Neurosurgery, Sylhet Womens Medical College Hospital, Sylhet.
Abstract
One of the most common surgical procedure performed is tonsillectomy. For post-tonsillectomy pain management two most commonly used drugs perioperatively are ketorolac and tramadol. To compare between ketorolac tromethamine and tramadol hydrochloride in post tonsillectomy pain management we obtained written informed consent from 71 (American Society of Anesthesiologist: grade: 1, 2) healthy patient aged 18-60 scheduled for elective tonsillectomy. The study was conducted at Shahjalal Hospital and Shahjalal Poly Clinic during the period of January 2022 to December 2023. Patients with history of gastric bleeding, renal impairment concurrent NSAID (Nonsteroidal anti-inflammatory drug) therapy, a history of major medical illness or a known intolerance to NSAIDs were not studied. 71 patients were divided into two groups: Ketorolac group (n=35 patients who received ketorolac tromethamine analgesia) and Tramadol group (n=36 patients who received tramadol hydrochloride). All patients were visited before surgery and the nature of the study and the use of a visual analogue scale pain scoring system was narrated. The visual analogue scale consisted of a 100 mm line with the left end signifying ‘no pain and the right end the ‘worst pain imaginable. The patients were asked to mark on the line corresponding to the severity of pain at rest. Patients were randomly selected before surgery to receive a single deep intramuscular injection of either ketorolac or Tramadol into the upper outer quadrant of the buttock. One hour after operation significantly lower pain scores was found in the ketorolac group. Pain scores at second and fourth hour postoperatively were not remarkably different between the two groups although six of those receiving tramadol required additional analgesia compared to one in the ketorolac group. Discomfort at the operation site was similar for both groups on the day following surgery. Both ketorolac and tramadol administered postoperatively after the surgery and continued postoperatively, both drugs effectively and equally controlled post-tonsillectomy pain with no serious adverse effects.