Abstract
Author(s): Khaled M. Alanwer*, Ahmed Alizein Elnizamy and Ayat Ahmed Amer
Background: Effective pain management following a Cesarean Section (CS) is vital for maternal recovery and early newborn bonding. This prospective cohort study aimed to compare the postoperative analgesic efficacy, time to first rescue analgesia request, and total 24-hour analgesic consumption between wound infiltrations with bupivacaine versus tramadol. Patients and methods: The study included 60 healthy women aged 18– 40 years undergoing elective CS under spinal anesthesia. Participants were randomly assigned to Group A (n=30), receiving intraincisional 2mg/kg tramadol, or Group B (n=30), receiving 0.25% bupivacaine. Primary outcomes included pain intensity, assessed using the Visual Analog Scale (VAS), at 1, 6, 12, and 24 hours postoperatively. Secondary outcomes were time to first rescue analgesia request, total diclofenac consumption, and incidence of adverse effects. Results: Baseline characteristics were similar between groups. While early VAS scores at 1 and 6 hours showed no significant difference (P > 0.05), the tramadol group demonstrated a statistically significant reduction in pain at 12 and 24 hours compared to bupivacaine (P < 0.001). Time to first rescue analgesia was markedly prolonged in the tramadol group (6.42 \pm 1.52 hours) compared to bupivacaine (2.75 \pm 0.58 hours; P < 0.001). Furthermore, cumulative 24-hour diclofenac consumption was significantly lower in the tramadol group. No significant differences in the incidence of postoperative nausea or vomiting were observed (P > 0.05). Conclusion: Wound infiltration with tramadol alone provides superior, prolonged analgesia compared to bupivacaine. It effectively delays the need for rescue analgesia and lowers VAS scores in the later postoperative period without increasing side effects.