Skip to main content Accessibility help

The postoperative analgesic efficacy of intraperitoneal tramadol compared to normal saline or intravenous tramadol in laparoscopic cholecystectomy

  • S. B. Akinci (a1), B. Ayhan (a1), I. O. Aycan (a1), B. Tirnaksiz (a2), E. Basgul (a1), O. Abbasoglu (a2), U. Aypar (a1) and I. Sayek (a2)...


Background and objective

The aim of this study was to compare the postoperative analgesic efficacy of intraperitoneal tramadol with intravenous tramadol or normal saline in patients undergoing laparoscopic cholecystectomy.


Sixty-one patients undergoing laparoscopic cholecystectomy were randomized to one of three groups in a double-blind manner via coded syringes. All patients received an intravenous and an intraperitoneal injection after installation of the pneumoperitoneum and again before removal of the trocars. In the control group, all injections were with normal saline. In the intravenous tramadol group, patients received intravenous tramadol 100 mg and intraperitoneal saline. In the intraperitoneal tramadol group, patients received intravenous saline and intraperitoneal tramadol 100 mg. All patients had a standard anaesthetic. Postoperative analgesia was with morphine. Postoperatively, numeric pain scores for parietal and visceral pain, 1 h and 24 h morphine consumption, and adverse effects were recorded.


Parietal and visceral pain scores were lowest in the intravenous tramadol group during the first postoperative hour (P < 0.016 compared with control). The delay until the first analgesic administration was longest in the intravenous tramadol group (median 23 min, range 1–45), when compared with the intraperitoneal tramadol group (10, 1–120 min, P = 0.263) or with the control group (1, 1–30 min, P = 0.015). One-hour morphine consumption was significantly lower in the intravenous tramadol group (mean ± SD; 3.4 mg ± 2.5) and in the intraperitoneal tramadol group (4.4 ± 4.3 mg) compared with the control group (6 ± 2 mg) (P = 0.044). There was no difference between the three groups regarding pain scores, morphine consumption and incidence of shoulder pain or adverse effects at 24 h.


Intravenous tramadol provides superior postoperative analgesia in the early postoperative period after laparoscopic cholecystectomy compared with an equivalent dose of tramadol administered intraperitoneally and with normal saline in patients undergoing laparoscopic cholecystectomy.


Corresponding author

Correspondence to: Seda B. Akinci, Department of Anaesthesiology and Reanimation, Hacettepe University School of Medicine, Sihhiye, Ankara06100, Turkey. E-mail:; Tel: +90 312 3051264; Fax: +90 312 3109600


Hide All
1.Joris, J, Thiry, E, Paris, P, Weerts, J, Lamy, M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 1995; 81: 379384.
2.Bisgaard, T, Klarskov, B, Bjerregaard Kristiansen, V et al. Multi-regional anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study. Anesth Analg 1999; 89: 10171024.
3.O’Hanlon, DM, Colbert, S, Ragheb, J, McEntee, GP, Chambers, F, Moriarty, DC. Intraperitoneal Pethidine versus intramuscular Pethidine for the relief of pain after laparoscopic cholecystectomy: randomized trial. World J Surg 2002; 26: 14321436.
4.Kehlet, H, Gray, AW, Bonnet, F et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 2005; 19: 13961415.
5.Bisgaard, T. Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 2006; 104: 835846.
6.Oliva, P, Aurilio, C, Massimo, F et al. The antinociceptive effect of tramadol in the formalin test is mediated by the serotonergic component. Eur J Pharmacol 2002; 445: 179185.
7.Robaux, S, Blunt, C, Viel, E et al. Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently. Anesth Analg 2004; 98: 11721177.
8.Altunkaya, H, Ozer, Y, Kargi, E, Babuccu, O. Comparison of local anesthetic effects of tramadol with prilocaine for minor surgical procedures. Br J Anaesth 2003; 90: 320322.
9.Altunkaya, H, Ozer, Y, Kargi, E, Ozkocak, I et al. The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic. Anesth Analg 2004; 99: 14611464.
10.Akinci, SB, Saricaoglu, F, Atay, OA, Doral, MN, Kanbak, M. Analgesic effect of intra-articular tramadol compared with morphine after arthroscopic knee surgery. Arthroscopy 2005; 21: 10601065.
11.Acalovschi, I, Cristea, T, Margarit, S, Gavrus, R. Tramadol added to lidocaine for intravenous regional anesthesia. Anesth Analg 2001; 92: 209214.
12.Aldrete, JA, Kroulik, D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924934.
13.Mannion, S, O’Callaghan, S, Murphy, DB, Shorten, GD. Tramadol as adjunct to psoas compartment block with levobupivacaine 0.5%: a randomized double-blinded study. Br J Anaesth 2005; 94: 352356.
14.Hama, A, Sagen, J. Altered antinociceptive efficacy of tramadol over time in rats with painful peripheral neuropathy. Eur J Pharmacol 2007; 559: 3237.
15.Matthiesen, T, Wohrmann, T, Coogan, TP, Uragg, H. The experimental toxicology of tramadol: an overview. Toxicol Lett 1998; 95: 6371.
16.Wills, VL, Hunt, DR. Pain after laparoscopic cholecystectomy. Br J Surg 2000; 87: 273284.
17.Krzek, J, Starek, M. Quality assessment for tramadol in pharmaceutical preparations with thin layer chromatography and densitometry. Biomed Chromatogr 2004; 18: 589599.
18.Parasrampuria, R, Vuppugalia, R, Elliott, K, Mehvar, R. Route-dependent stereoselective pharmacokinetics of tramadol and its active O-demethylated metabolite in rats. Chirality 2007; 19: 190196.
19.Barczynski, M, Konturek, A, Herman, RM. Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc 2006; 20: 10881093.
20.Naguib, M, Attia, M, Samarkandi, AH. Wound closure tramadol administration has a short-lived analgesic effect. Can J Anaesth 2000; 47: 815818.
21.Pozos-Guillen, AJ, Aguirre-Banuelos, P, Arellano-Guerrero, A et al. Isobolographic analysis of the dual-site synergism in the antinociceptive response of tramadol in the formalin test in rats. Life Sci 2006; 79: 22752282.


The postoperative analgesic efficacy of intraperitoneal tramadol compared to normal saline or intravenous tramadol in laparoscopic cholecystectomy

  • S. B. Akinci (a1), B. Ayhan (a1), I. O. Aycan (a1), B. Tirnaksiz (a2), E. Basgul (a1), O. Abbasoglu (a2), U. Aypar (a1) and I. Sayek (a2)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed