Analgesic outcomes of tramadol alone and in combination with Butorphanol or Flurbiprofen Axetil after cesarean section: a retrospective study with propensity score matching analysis

Abstract

Background The Society for Obstetric Anesthesia and Perinatology recommends a multimodal analgesia regimen for cesarean delivery analgesia. This study aimed to compare the analgesic effects of tramadol alone and combined with butorphanol or flurbiprofen axetil after a cesarean section. Methods We performed a retrospective analysis based on the electronic medical records of a teaching hospital in China from January 2018 to January 2020. We collected data on demographic characteristics, anesthesia, analgesia strategy, and pain intensity postoperatively during the first 48 hours. Inadequate postoperative analgesia during this period was defined as an NRS score ≥ 4. We also collected data regarding off-bed activity and intestinal function recovery. Participants were classified into three groups according to analgesia regimens. Groups T, TF, and TB received tramadol, a mixture of tramadol and flurbiprofen axetil, and a combination of tramadol and butorphanol, respectively. Analgesic outcomes were compared using propensity score matching analysis. Results Data from 2323 cases of caesarean section were included in the analysis, and 521 pairs were matched in each group according to their propensity score. Compared with group T, The inadequate analgesia on pain at rest and pain at movement was lower in group TF (RR: 0.42, 95% CI: 0.36–0.49, P = 0.001 and RR: 0.58, 95% CI: 0.48–0.69, P < 0.001, respectively),and the incidence of inadequate control of pain at movement was higher in group TB (RR: 1.38, 95% CI: 1.22–1.55, P < 0.001). Additionally, the percentage of off-bed activity at 2 days postoperatively was higher in group TB than in groups TF and T (78.7% vs. 68.5 and 78.7% vs. 64.9%, respectively, P < 0.001). The incidence of intestinal function recovery 2 days after cesarean delivery in group TB was higher than that in group TF (73.3% vs. 66.2%, P = 0.013). Conclusions Combining tramadol and flurbiprofen axetil could enhance the analgesic effect and be safely used for analgesia after a cesarean section. However, combining tramadol and butorphanol may produce an antagonistic effect.

Effect of Personality and Pain Catastrophizing on Postoperative Analgesia Following Cesarean Section: A Prospective Cohort Study

“…In our study, women undergoing cesarean delivery still experienced obvious postoperative pain, despite receiving routine postoperative PCIA; the incidence of inadequate postoperative analgesia was as high as 89.85%, which is similar to that reported by Borges et al, 24 but much higher than that reported by Bekele et al 25 Another study of 2323 Chinese women who underwent cesarean section showed that 59.1% of women had inadequate analgesia 48 h after surgery, despite using a mixture of tramadol and furoprofen acetate. 3 One reason for our result is that we used a 24-h activity NRS score of ≥4 to assess inadequate analgesia, and the analgesia score at 24 h was higher than that at 48 h, thereby the incidence of analgesia is higher. Furthermore, the numerical pain scale used was subjective, and the results might differ in people with different ethnic and cultural backgrounds.…”

“… 2 Due to the influence of postpartum contractions and surgical incisions, women undergoing cesarean section often experience severe postoperative pain. 3 , 4 However, despite the numerous measures developed to manage postoperative pain, inadequate analgesia following cesarean section was common, with an incidence of 68–76%. 5 , 6 Inadequate pain treatment and a high risk of severe acute pain could be possible explanations.…”