comparing the efficacy and safety of rectal diclofenac versus intramuscular tramadol for postoperative pain management in adult patients undergoing fistula in ano surgery in a tertiary care centre : A randomised controlled trial

Postoperative pain management is a critical factor in recovery following anorectal surgeries such as fistula in ano. While tramadol is a commonly used central analgesic in India, it often fails to target local inflammatory pain and is associated with significant side effects like nausea and vomiting. This prospective, randomized controlled trial was conducted at a tertiary care centre in Chennai to compare the efficacy of 100 mg rectal diclofenac suppositories against 50 mg intramuscular tramadol.   The study enrolled 60 adult patients (ASA I–II) who were randomized into two equal groups of 30. Both groups received standardized background analgesia with intravenous paracetamol. Pain intensity was measured using the visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively. The results demonstrated that the diclofenac group had significantly lower pain scores at 6 and 12 hours compared to the tramadol group. Furthermore, the incidence of nausea was significantly lower in the diclofenac group (6.7 percent) compared to the tramadol group (33.3 percent). The study concludes that rectal diclofenac provides superior intermediate-phase analgesia and better tolerability, making it an effective opioid-sparing option for fistula surgery.