Comparison of the postoperative analgesic effects of preemptive paracetamol, paracetamol-diclofenac and paracetamol-tramadol in patients undergoing elective abdominal surgery at a tertiary care hospital, Karachi

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Objective: To compare the postoperative analgesic effects of preemptive paracetamol, paracetamol-diclofenac, and paracetamol-tramadol in patients undergoing elective abdominal surgery at a tertiary care hospital in Karachi. Study Design: Quasi-experimental Study. Place And Duration Of The Study. Department of Anesthesiology, Civil Hospital, Karachi, from February 2026 to June 2026. Methodology: The sample of ninety adults (20–60 years old) with ASA physical status I or II undergoing elective abdominal surgery were randomly split into three arms: paracetamol, paracetamol and diclofenac, and paracetamol and tramadol. Total analgesic consumption and time until the first analgesic request were recorded and compared using a one-way ANOVA, with Tukey HSD posthoc pairwise comparisons and stratification by age, sex, ASA class and comorbidity. Result: Total analgesic consumption differed across groups (p < 0.001), measuring 250.00 ± 90.53 mg with paracetamol, 173.82 ± 80.73 mg with diclofenac, and 154.76 ± 74.97 mg with tramadol. The time to meet the first analgesic requirement lengthened from 87.62± 21.59 minutes in the paracetamol arm to 103.00± 21.92 minutes with diclofenac and 144.05± 15.61 minutes with tramadol (p < 0.001). Both combinations reduced consumption compared with paracetamol alone, and the tramadol combination produced the longest analgesic interval. Conclusion: Preemptive combination analgesia was associated with superior early postoperative pain control compared with paracetamol alone in patients undergoing elective abdominal surgery. The paracetamol-tramadol combination had the lowest overall analgesic use and the longest time to the first dose of analgesic, suggesting that this pre-emptive combination offered the best postop pain relief in the first 24 hours.

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