Comparative Efficacy Of Intravenous Fentanyl Versus Tramadol For Postoperative Pain Management Following Appendectomy: A Prospective Randomized Study

Background: Effective postoperative pain management remains a critical component of surgical care, significantly influencing patient recovery and clinical outcomes. Appendectomy, one of the most commonly performed emergency surgical procedures worldwide, necessitates optimal analgesic strategies to minimize postoperative discomfort and facilitate early mobilization. Both fentanyl and tramadol are widely utilized for postoperative analgesia, yet comparative evidence regarding their efficacy and safety profiles in appendectomy patients remains limited.

Methods: This prospective randomized controlled trial was conducted from June 2023 to July 2024 at a tertiary care teaching hospital. A total of 100 patients undergoing emergency or elective appendectomy were randomly allocated into two equal groups: Group F received intravenous fentanyl (1 µg/kg) and Group T received intravenous tramadol (1 mg/kg) for postoperative analgesia. Pain intensity was assessed using the Visual Analogue Scale at multiple time intervals (0, 2, 4, 6, 12, and 24 hours postoperatively). Secondary outcomes included time to first rescue analgesia, total analgesic consumption, adverse effects, and patient satisfaction scores.

Results: The fentanyl group demonstrated significantly lower mean VAS scores compared to the tramadol group at 2 hours (2.34±0.82 vs 3.76±1.12, p<0.001), 4 hours (2.68±0.94 vs 3.92±1.24, p<0.001), and 6 hours (3.12±1.08 vs 4.28±1.36, p<0.001) postoperatively. Time to first rescue analgesia was significantly prolonged in Group F (4.82±1.26 hours vs 3.34±0.98 hours, p<0.001). The incidence of nausea and vomiting was higher in the tramadol group (34% vs 18%, p=0.048), while both groups showed comparable rates of other adverse effects. Patient satisfaction scores were significantly higher in the fentanyl group (8.24±1.12 vs 7.16±1.48, p<0.001).

Conclusion: Intravenous fentanyl provided superior postoperative analgesia with better pain control, prolonged duration of action, and higher patient satisfaction compared to tramadol in patients undergoing appendectomy, with an acceptable adverse effect profile. These findings support the preferential use of fentanyl for postoperative pain management in appendectomy patients.