Study of Efficacy of Presumptive Use of Intravenous Tramadol 50 mg Prior to Incision in Patients Undergoing General Anesthesia – Reducing Anesthesia Drug Requirement and Surgical Response

Preemptive administration of analgesics aims to prevent central sensitization, potentially minimizing surgical stress and reducing anesthetic requirements. Tramadol, a synthetic opioid with multimodal analgesic properties, may be beneficial when administered before surgical incision. This prospective, randomized, double-blinded, controlled trial aimed to evaluate the efficacy of a single 50 mg intravenous dose of tramadol, given 15 minutes pre-incision, in reducing intraoperative anesthetic drug consumption and attenuating hemodynamic responses in sixty American Society of Anesthesiologists (ASA) physical status I or II adult patients undergoing elective laparoscopic cholecystectomy under general anesthesia, allocated to receive either tramadol 50 mg IV (Group T, n=30) or normal saline (Group C, n=30). Key outcome measures included total intraoperative propofol and fentanyl consumption, hemodynamic parameters (heart rate and mean arterial pressure) at various time points, and postoperative pain assessed by Visual Analogue Scale (VAS) at 1, 2, 4, 6, 12, and 24 hours, alongside postoperative sleep quality on the first postoperative night using the Richards-Campbell Sleep Questionnaire (RCSQ). Patients in Group T required significantly lower mean doses of propofol (82.4 ± 15.6 mg vs. 115.8 ± 17.3 mg, p <0.001) and fentanyl (94.6 ± 12.1 µg vs. 127.3 ± 10.4 µg, p <0.001) compared to Group C. Hemodynamic stability was better maintained in Group T, particularly post-incision, with significantly attenuated increases in heart rate and mean arterial pressure. Postoperative VAS scores at 2, 4, 8, 12, 16 and 24 hours were notably lower in Group T (e.g., 2 hour: 2.7±0.2 vs 3.9±0.2, p=0.008; 24 hour: 0.7±0.2 vs 1.5±0.2, p=0.03). Sleep quality scores (RCSQ) were also significantly better in Group T (e.g., 70±10 vs 56±11, p=0.002). Preemptive intravenous tramadol 50 mg effectively reduces intraoperative anesthetic and opioid requirements, improves hemodynamic stability, contributes to better early postoperative analgesia and sleep quality without a significant increase in adverse effects in patients undergoing elective laparoscopic cholecystectomy.