tramadol (Qdolo)

Postoperative analgesic outcomes of fascia iliaca compartment block versus pericapsular nerve group block in hip fracture surgery: a retrospective observational study.

Karataş Sevim Şenol SŞ, Öner Sait Fatih SF

Hip fracture surgery is associated with substantial postoperative pain, delayed mobilization, and increased opioid requirements, particularly in older adults. Ultrasound-guided regional nerve blocks are increasingly used as components of multimodal analgesia. This study compared postoperative analgesic outcomes between fascia iliaca compartment block (FICB) and pericapsular nerve group (PENG) block in patients undergoing hemiarthroplasty for hip fracture. This retrospective single-center cohort study included all 186 eligible adult patients who underwent hemiarthroplasty for hip fracture under spinal anesthesia between October 2022 and October 2024. Patients received either ultrasound-guided FICB (n = 90) or PENG block (n = 96) before surgery. The primary outcome was postoperative visual analogue scale (VAS) score at 6 h. Secondary outcomes included VAS score at 24 h, cumulative tramadol consumption during the first postoperative 24 h, quality of recovery assessed using the QoR-15, hospital length of stay, and intraoperative hemodynamic parameters. Separate multivariable linear regression models were used to adjust for age, sex, and ASA physical status. Baseline characteristics were comparable between groups. Patients receiving PENG block had significantly lower postoperative VAS scores at 6 h (3.42 ± 0.90 vs. 5.04 ± 1.24; mean difference - 1.63, 95% CI - 1.94 to - 1.32; p < 0.001) and at 24 h (5.29 ± 0.86 vs. 6.40 ± 0.91; mean difference - 1.11, 95% CI - 1.36 to - 0.85; p < 0.001). Cumulative 24-hour tramadol consumption was significantly lower in the PENG group (243.98 ± 54.27 mg vs. 347.89 ± 65.87 mg; mean difference - 103.91 mg, 95% CI - 121.32 to - 86.49; p < 0.001). QoR-15 scores were significantly higher following PENG block (91 [88-93] vs. 83 [80-85]; p < 0.001). After adjustment for age, sex, and ASA physical status, PENG block remained independently associated with lower VAS scores at 6 and 24 h and lower 24-hour tramadol consumption. Compared with FICB, PENG block was associated with lower postoperative opioid requirements, lower early postoperative pain scores, and improved patient-reported quality of recovery following hemiarthroplasty for hip fracture. The reduction in postoperative tramadol consumption appears to represent the most clinically relevant finding. Prospective randomized multicenter studies are warranted to confirm these observations.

Postoperative Analgesic Efficacy of a Novel Surgical Modified Serratus Anterior Plane Block in Reduction Mammaplasty: A Prospective Randomized Controlled Trial.

Sonmez Ayhan A, Kokten Alperen Can AC, Kayikci Ebru E, Bulbuloglu Ismail I et al.

Postoperative analgesia after reduction mammaplasty remains challenging, particularly given the extent and distribution of surgical dissection. While ultrasound-guided interfascial plane blocks are commonly used, their timing and reliability may be influenced by surgical duration and tissue manipulation. We investigated whether a surgically administered serratus anterior plane block, applied under direct visualization immediately before wound closure, could enhance postoperative analgesia. In this prospective randomized controlled trial, patients undergoing reduction mammaplasty were assigned to receive either a bilateral surgical serratus anterior plane block in addition to standardized multimodal analgesia or standard analgesia alone. The block was performed intraoperatively by the surgeon without ultrasound guidance. The primary endpoint was cumulative tramadol consumption within the first 24 postoperative hours. Secondary outcomes included postoperative pain intensity, time to first analgesic request, and opioid-related adverse effects. Fifty-six patients completed the study. Patients receiving the surgical serratus anterior plane block demonstrated lower pain scores in the early postoperative period, while pain intensity became comparable between groups later during follow-up. Despite this convergence, opioid consumption remained consistently lower in the block group throughout the first 24 hours, with a 43% reduction in cumulative tramadol use at 24 hours. In addition, the time to first postoperative analgesic demand was significantly prolonged in the block group. No block-related complications were observed. A surgically performed serratus anterior plane block applied immediately before wound closure was associated with a sustained opioid-sparing effect after reduction mammaplasty. This intraoperative approach may offer a practical alternative to ultrasound-guided techniques; however, further studies are required to refine the technique and define its role within enhanced recovery pathways. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ziade-Benítez José J, Orozco María Trinidad MT, Olivera Mario J MJ, Parra Édgar É et al.

Se presenta un caso de ruptura esplénica patológica asociada a malaria complicada por Plasmodium vivax en un paciente de sexo masculino, de 28 años, procedente de El Retorno (Guaviare). El paciente fue hospitalizado con fiebre, dolor en el hemitórax izquierdo, vómito, diarrea, taquicardia, taquipnea, hipotensión y signos de  inestabilidad hemodinámica, asociados con un estado de choque hipovolémico. Al ingreso, se le administró tratamiento analgésico intramuscular con 500 mg de dipirona y 100 mg de tramadol, y líquidos intravenosos. En el hemograma se encontró neutrofilia y plaquetopenia, y la gota gruesa fue positiva para P. vivax con 24 000 parásitos por μl. Durante su estancia hospitalaria -que se prolongó por solo 4 horas-, el paciente experimentó un deterioro progresivo de su estado general, que culminó en paro cardiorrespiratorio que no respondió a las maniobras de reanimación y resultó en su fallecimiento. En el estudio histopatológico de bazo se evidenciaron agregados de neutrófilos polimorfonucleares y plasmocitosis. El paciente no alcanzó a recibir tratamiento antimalárico parenteral. La ruptura esplénica asociada a la malaria es una complicación grave y potencialmente mortal. Por ello, toda esplenomegalia dolorosa en un episodio agudo de malaria debe considerarse como un signo de alarma de posible ruptura esplénica. Es esencial fortalecer la sensibilización de los equipos médicos locales sobre esta complicación, promoviendo el diagnóstico y el tratamiento oportunos para mejorar los desenlaces clínicos.

A Comparative Study of the Analgesic Efficacy of Tramadol and Diclofenac Sodium in Patients Following Cesarean Section.

Brahmbhatt Shruti S, Shah Devashree D, Rajput Heena H, Patel Hitanshi B HB

Effective postoperative pain control is an essential component of patient care. Cesarean section is one of the most common surgical procedures, and adequate post-cesarean pain management is necessary to facilitate enhanced recovery, improve neonatal outcomes by promoting breastfeeding and mother-infant bonding, and reduce pain-related adverse effects. Although opioids have been the mainstay of postoperative analgesia, their adverse effects limit their use. Non-steroidal anti-inflammatory drugs have gained popularity as alternatives. This prospective observational comparative study was conducted at a tertiary care hospital in Gujarat among female patients aged >18 years who had undergone cesarean delivery and were prescribed either tramadol or diclofenac sodium for postoperative pain management by the treating clinician. Pain was assessed using the Visual Analog Scale (VAS) at baseline and at 30 minutes, two, six, 12, and 24 hours. Adverse drug reactions were recorded. Statistical analysis was performed using standard parametric tests, with p < 0.05 considered significant. A total of 50 participants completed the study (tramadol group: n = 25; diclofenac group: n = 25), with comparable baseline characteristics. Both groups showed significant improvement in VAS scores over time (intra-group p < 0.001). Inter-group comparison demonstrated a statistically significant difference at 30 minutes, two hours, and six hours (p < 0.05), but not at 12 and 24 hours (p > 0.05). The mean reduction in VAS score at two hours was 2.4 in the tramadol group and 2.92 in the diclofenac group. The incidence of adverse drug reactions was comparable between groups (p > 0.05). Both diclofenac sodium and tramadol are effective in reducing postoperative pain following a cesarean section. Diclofenac provides a faster onset of analgesia, while tramadol offers sustained pain relief. Adverse drug reaction incidence was similar in both groups, although gastrointestinal symptoms were more common with diclofenac. Analgesic choice should be individualized based on patient factors, contraindications, and clinical context.