Toward Opioid-Free Analgesia: Metamizole–Ketamine versus Metamizole–Tramadol in Orthopedic Postoperative Pain Management

Abstract

Background: Postoperative pain is a common issue among patients undergoing surgery. Inadequate management of postoperative pain can affect quality of life, prolong recovery, increase the risk of postoperative complications, and contribute to the development of persistent postoperative pain. Major orthopedic surgery is one of the procedures associated with high levels of postoperative pain; therefore, effective pain management is essential to accelerate recovery and improve postoperative quality of life. A multimodal analgesia approach has been studied to help manage postoperative pain in orthopedic patients. Limited data on the effectiveness of the metamizole–ketamine combination compared to metamizole–tramadol in postoperative pain management forms the basis for conducting this study.

Objective: To analyze the difference in pain scores at 6, 12, 18, and 24 hours postoperatively between the administration of metamizole–ketamine and metamizole–tramadol combinations in adult patients undergoing major orthopedic surgery.

Research Method: This was a prospective analytic quasi-experimental study conducted at Universitas Airlangga Hospital involving 20 patients aged 18–65 years who underwent major orthopedic surgery and met the inclusion and exclusion criteria. Data collected included baseline characteristics, pain scores evaluated using Numeric Rating Scale, and side effects following the administration of either the metamizole–ketamine or metamizole–tramadol combination. The collected data were analyzed using SPSS software.

Results: A significant difference in pain scores was found at 18 and 24 hours postoperatively, with the metamizole–ketamine group showing lower pain scores compared to the metamizole–tramadol group (p = 0.048 and p = 0.038, respectively).

Conclusion: The combination of metamizole–ketamine results in lower pain scores at 18 and 24 hours after major orthopedic surgery compared to the combination of metamizole–tramadol.