An important goal of modern anesthesia is to ensure that patients having surgery awake from anesthesia with good pain control. A good strategy to achieve this goal is to prevent rather than treat sever postoperative pain. This study was designed to evaluate and compare the preemptive analgesia with tramadol given either intramuscular, intravenous or epidural before skin incision in addition to general anesthesia. Pain scores, glucose and stress hormones: thyroxin and cortisol were monitored.