Postoperative pain is one of the most unpleasant experiences for a patient undergoing. Developing postoperative pain should be managed early and aggressively, because severe pain can induce a delay in discharge and poorer patient satisfaction along with hyperalgesic condition. The tramadol and paracetamol combination is often used for postoperative pain management. There is very literature on the use of this combination for vertebral surgery.

A prospective randomized triple-blind clinical trial was conducted at Aga Khan University Hospital, Karachi. Its objective was to compare combinations of Tramadol – Paracetamol for Postoperative Pain Relief in Elective Single-level Microdisectomy Surgery.

So it had two groups, group 1T with combination- (1 g paracetamol and a lower dose of tramadol (1 mg/kg:)and group 1.5T. with a combination (1 g paracetamol and a higher dose of tramadol (1.5 mg/kg:) for postoperative pain after microdisectomy surgery. For this main outcome measure used postoperatively for 4 hours was Visual Analogue Scale pain scores.

This trial involved 94 patients between 18 and 50 years of age, scheduled for elective single-level microdisectomy and were allocated randomly into 1 of 2 groups. The respective study drug combination was given to patients 20 minutes before the surgery end.

So the results identified no any notable demographic difference between groups. None of the patients experienced severe pain (VAS>6). Even there was no major difference in the mean pain score between groups, which at 4 hours was 2.17 (1.38) in group 1.5T and 1.74 (1.37) in group 1T. The difference was not statistically significant (P=0.14). Nausea and vomiting was reported in 13 patients in 1.5T group, compared to 1T group in 2 patients, which was statistically significant difference (P=0.004). The sedation score was similar between groups.

So this study concluded that the combination of low-dose tramadol (1 mg/kg) and paracetamol has comparable analgesia and a decreased incidence of nausea and vomiting compared with the higher dose of tramadol (1.5 mg/kg) and paracetamol combination.