POST-OPERATIVE ANALGESIC EFFECTS OF TRAMADOL AND NALBUPHINE IN SMOKER AND NON-SMOKER PATIENTS FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Background: Effective postoperative pain management is essential for recovery after laparoscopic cholecystectomy. Analgesic requirements can differ between smokers and nonsmokers due to variations in pain perception and opioid metabolism. Tramadol and nalbuphine are widely used opioids for controlling postoperative pain. Understanding their comparative effectiveness in these two groups is crucial for tailoring pain management strategies and improving surgical outcomes.

Objective: To evaluate postoperative pain severity in smokers and nonsmokers undergoing laparoscopic cholecystectomy and to compare the analgesic effects of tramadol and nalbuphine in both groups.

Methods: This comparative cross-sectional study included 100 patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients were divided equally into smokers (n=50) and nonsmokers (n=50). Each group was further subdivided, with 25 patients receiving tramadol and 25 patients receiving nalbuphine. Smokers were defined as individuals consuming ≥10 cigarettes per day, while patients with other forms of tobacco use were excluded. Pain severity was assessed postoperatively using the Visual Analogue Scale (VAS) at 1, 2, 3, and 4 hours. Analgesic dosages and frequency of administration were recorded. Data were analyzed using descriptive statistics and one-way ANOVA.

Results: In smokers receiving tramadol, VAS scores showed 7 patients with mild pain, 9 with moderate, 8 with severe, and 1 with very severe pain. In nonsmokers on tramadol, 9 reported mild pain, 7 moderate, 7 severe, and 2 very severe. Among smokers receiving nalbuphine, 9 reported mild pain, 8 moderate, 6 severe, and 2 very severe, whereas nonsmokers reported 7 mild, 14 moderate, 3 severe, and 1 very severe. Tramadol dosage was predominantly 100 mg in smokers and nonsmokers, while nalbuphine was administered at higher doses (34–40 mg) in smokers compared with lower doses (14–20 mg) in nonsmokers. Analgesic repetition was required more frequently in smokers than nonsmokers.

Conclusion: Smokers demonstrated greater postoperative analgesic requirements compared with nonsmokers. Nalbuphine was more effective in smokers, while both tramadol and nalbuphine were equally effective in nonsmokers. The higher dosing and frequency of analgesic use in smokers highlight the need for tailored pain management strategies in this group.