Effectiveness of Local Infiltration versus Intramuscular Injection of Tramadol Following Inguinal Herniorrhaphy in Adult Patients at Kayunga Regional Referral Hospital

Effectiveness of Local Infiltration versus Intramuscular Injection of Tramadol Following Inguinal Herniorrhaphy in Adult Patients at Kayunga Regional Referral Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Effectiveness of Local Infiltration versus Intramuscular Injection of Tramadol Following Inguinal Herniorrhaphy in Adult Patients at Kayunga Regional Referral Hospital Cyprien Anzako Amako¹, Bienfait Mumbere Vahwere¹&, Ahmed Kiswezi¹, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8329219/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Background : Inguinal hernia repair is one of the most frequently performed operations worldwide, yet optimal postoperative pain control remains a major clinical challenge, especially in resource-limited settings. Tramadol, a dual-acting opioid and monoaminergic analgesic, provides moderate yet well-tolerated analgesia when administered either systemically or locally. Although its local infiltration has shown promising results, direct comparisons with intramuscular (IM) administration for acute postoperative pain management remain limited. Methods : This prospective, randomized, double-blind, controlled study will enroll 88 adult patients undergoing elective, uncomplicated inguinal herniorrhaphy at Kayunga Regional Referral Hospital in Uganda. Participants will be randomly allocated to receive tramadol 2 mg/kg diluted in 10 ml of normal saline either by local wound infiltration (Group A) or intramuscular injection (Group B) at wound closure. Pain intensity will be assessed using the Visual Analog Scale (VAS) at 4, 6, 12, and 24 hours postoperatively. Secondary outcomes will include the duration of pain-free interval, need for rescue analgesia, and time to first rescue dose. Data will be analyzed using SPSS v22, applying the Mann–Whitney U and Poisson regression tests where appropriate. Discussion : The primary outcome of this study is to compare the occurrence of postoperative pain following open herniorrhaphy using the Visual Analog Scale (VAS) at 4, 6, 12, and 24 hours postoperatively. Additionally, the median operative time from the induction of anesthesia to the completion of the surgical procedure and the cost-effectiveness of the two techniques will be evaluated in both groups. Local infiltration of tramadol following herniorrhaphy under spinal anesthesia has the potential to provide significant benefits to patients, most notably by prolonging pain-free periods, which may lead to greater patient satisfaction and reduced healthcare costs. Conclusions : Local Tramadol infiltration offers superior, longer-lasting, and safer analgesia compared to intramuscular administration after inguinal hernia repair. Its simplicity, affordability, and effectiveness make it a valuable postoperative pain management option, particularly in low-resource settings. Incorporating local tramadol infiltration into multimodal analgesic protocols may enhance postoperative recovery and reduce supplementary analgesic requirements. Trial registration: Pan-African Control Trials Registry (N ̊ PACTR 202510801818332). Registered on 20 th October 2025 Inguinal hernia postoperative pain Tramadol local infiltration intramuscular injection analgesia Uganda Full Text Additional Declarations No competing interests reported. Supplementary Files SPIRIT2025RCTTRAMADOLchecklistED.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 10 Apr, 2026 Reviews received at journal 10 Apr, 2026 Reviews received at journal 09 Apr, 2026 Reviews received at journal 22 Mar, 2026 Reviewers agreed at journal 21 Mar, 2026 Reviewers agreed at journal 20 Mar, 2026 Reviews received at journal 17 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers invited by journal 15 Mar, 2026 Editor assigned by journal 11 Dec, 2025 Submission checks completed at journal 11 Dec, 2025 First submitted to journal 10 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8329219","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":607011404,"identity":"4ff7fbcf-0213-4c59-b632-8f41fb3cd7d9","order_by":0,"name":"Cyprien Anzako Amako¹","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Cyprien","middleName":"Anzako","lastName":"Amako¹","suffix":""},{"id":607011408,"identity":"5c92b0e5-d79a-45cc-b5a9-ea1bfdff3370","order_by":1,"name":"Bienfait Mumbere 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Tramadol, a dual-acting opioid and monoaminergic analgesic, provides moderate yet well-tolerated analgesia when administered either systemically or locally. Although its local infiltration has shown promising results, direct comparisons with intramuscular (IM) administration for acute postoperative pain management remain limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e:\u003cbr\u003e\nThis prospective, randomized, double-blind, controlled study will enroll 88 adult patients undergoing elective, uncomplicated inguinal herniorrhaphy at Kayunga Regional Referral Hospital in Uganda. Participants will be randomly allocated to receive tramadol 2 mg/kg diluted in 10 ml of normal saline either by local wound infiltration (Group A) or intramuscular injection (Group B) at wound closure. Pain intensity will be assessed using the Visual Analog Scale (VAS) at 4, 6, 12, and 24 hours postoperatively. Secondary outcomes will include the duration of pain-free interval, need for rescue analgesia, and time to first rescue dose. Data will be analyzed using SPSS v22, applying the Mann–Whitney U and Poisson regression tests where appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The primary outcome of this study is to compare the occurrence of postoperative pain following open herniorrhaphy using the Visual Analog Scale (VAS) at 4, 6, 12, and 24 hours postoperatively. Additionally, the median operative time from the induction of anesthesia to the completion of the surgical procedure and the cost-effectiveness of the two techniques will be evaluated in both groups. Local infiltration of tramadol following herniorrhaphy under spinal anesthesia has the potential to provide significant benefits to patients, most notably by prolonging pain-free periods, which may lead to greater patient satisfaction and reduced healthcare costs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e:\u003cbr\u003e\nLocal Tramadol infiltration offers superior, longer-lasting, and safer analgesia compared to intramuscular administration after inguinal hernia repair. Its simplicity, affordability, and effectiveness make it a valuable postoperative pain management option, particularly in low-resource settings. Incorporating local tramadol infiltration into multimodal analgesic protocols may enhance postoperative recovery and reduce supplementary analgesic requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003ePan-African Control Trials Registry (N ̊ PACTR 202510801818332). 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