Background: Severe postsurgical pain continues to be hard to manage in patients who experience breast cancer surgery. Badly managed pain can lead to meager patient satisfaction, prolonged hospital stay, and increased risk of complication by analgesics, and may be a reason in the development of long-lasting pain.

Aim: To compare the efficacy of Intravenous Tramadol and Bupivacaine irrigation through surgical drains after Modified Radical Mastectomy in patients with carcinoma breast.

Methods: This was a randomized controlled trial conducted in the Department of Anesthesia, Mayo Hospital Lahore. Total 70 female patients aged 18-70 years undergoing radical mastectomy for CA breast diagnosed on histopathology were selected. Patients were divided into two groups A and B through simple random sampling technique. Group A received intravenous Tramadol. Group B received Bupivacaine through surgical drains.

Results: At 0, 2, 4 and 6 hour postoperatively no significant difference was seen in severity of pain in both treatment groups. In Group-A at  0, 2, 4 and 6 hour postoperatively, 68.8%, 71.4%, 57.1% and 60% respectively had reported no pain while in Group-B at  0, 2, 4 and 6 hour postoperatively, 48.6%, 65.7%, 45.7% and 54.3% patients had reported no pain. Complaints of Nausea, vomiting, sedation, urinary retention was higher in patients in Tramadol Group as compared to Bupivacaine Group. 

Conclusion: Results of this study demonstrated that bupivacaine administrated through surgical drain was equally effective as intravenous tramadol for controlling postoperative mastectomy pain with less side effects.  

Keyword: Breast Cancer, Acute Pain, Analgesia, Tramadol, Bupivacaine, Radical Mastectomy, Nausea, Vomiting, Sedation, Urinary retention, Hypotension