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A comparative study of paracetamol and tramadol in pain management in hemophilic patients

Nalini G K, Deepak P, Suresh R M, Raghu N, Sahana G N, Jayashree V Nagaral, Neelamma Patil, Bhavishya Keerthi Anna Valder, Manjula M J, Anusha J, Karthik V, Lokesh J.


Background: Hemophilia-an X linked congenital bleeding disorder because of deficiency in the coagulation factor VIII (in hemophilia A) or factor IX (in hemophilia B). The deficiency is due to the result of mutations of the clotting factor genes. Acute and chronic pain is commonly seen pain with hemophilia patients. Assessing of the cause of pain is essential for proper management. The choice of appropriate pain-relieving measures is difficult and challenging, as there are many complex factors affecting pain perception. There may be differences in patient’s experiences and their response to pain; hence, an individualized approach to pain management is required.

Aim and Objectives: The objectives of the study were (i) to assess the efficacy of Paracetamol and Tramadol in pain management among hemophilic patient and (ii) to assess the adverse drug monitoring of Paracetamol and Tramadol among hemophilic patient.

Materials and Methods: This study was a hospital-based prospective and observational crossover study, conducted at Hassan institute of Medical Sciences, Hassan, A 800 bedded multispecialty tertiary care teaching hospital over a period of 6 months (March 2019-August 2019). A prospective, observational, and crossover study, conducted on diagnosed and confirmed cases of hemophilia total 18 patients, age ranging from 18 to 50 years and being treated with Paracetamol 500 mg TID for 5 days followed washout period of 7 days, then Tramadol 50 mg BID for 5 days. Pain assessment (Visual analog scale) is done before (baseline) and after 5 days of each drugs. The results were analyzed using descriptive statistics.

Results: In our study, out of 18 male patients who are enrolled in the study from inpatient medicine department, patients belonged to age group of 18–50 years. Statistical Significant decrease in pain was seen with Tramadol compared to Paracetamol.

Conclusion: Tramadol 50 mg BD is better than Paracetamol 500mg TID for pain management in hemophilia patients. As all patients would be suffering from deep seated pain, which is resolved by weak Opiod. Safer alternative for mild pain relief is Paracetamol (11%). Life expectancy and Quality of life will be improved with appropriate pain relief medication.

Key words: Hemophilia; Paracetamol; Tramadol; Pain Management

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