Anelgesic Efficacy of Intra-Thecal Tramadol as a Spinal Adjunct to 0.5% Heavy Bupivacaine in Lower Abdominal Surgery
Abstract
Introduction: Hyperbaric Bupivacaine is the most widely
used local anesthetic. A number of adjuvants have been used
with local anesthetic agents in order to improve the quality
and duration of analgesia and anesthesia. This study was
carried out to assess the efficacy of intrathecal Tramadol as
a spinal adjunct to prolong the duration of spinal anesthesia
in lower abdominal surgeries.
Materials and Methods: Sixty patients aged between
18 to 80 years, were randomly divided into two groups -
Tramadol and Placebo group. Spinal anesthesia was given
by using 25 Gauge Quinke spinal needle in sitting position
with midline approach. Patients belonging to Tramadol
group received 3 ml of 0.5% Bupivacaine along with 0.5
ml of Tramadol (25mg) and patients belonging to Placebo
group received 3 ml of 0.5% Bupivacaine along with 0.5
ml of Normal Saline. In the postoperative ward, duration
of analgesia was assessed by the time when first rescue
analgesia was given. Visual Analogue Scale for pain was
noted at the time of rescue analgesia. The total amount of
opioid consumed over 24 hour postoperative period was
noted. Hemodynamic like heart rate, systolic, diastolic and
mean arterial blood pressures were also noted. Data were
analyzed using independent t-test for continuous variables
and chi-square test for categorical variables, p value <0.05
was considered significant.
Results: The two groups were comparable with respect to
age, weight, sex, ASA grading and duration of surgery. Mean
duration of effective analgesia was 231.53 ± 22.00 min in
Tramadol group and 125.40 ± 8.86 min in Placebo group
(p = 0.001). The mean total amount of opioid consumption
in 24 hours postoperative period was 145.00 ± 30.31 mg
in Tramadol group and 171.67 ± 36.39 mg in Placebo
group (p = 0.003). Mean of Heart rate, systolic, diastolic
and mean arterial blood pressures were not significant
between the two groups. Incidence of nausea and vomiting
was statistically significant between the two groups with
a p value of 0.010. Hypotension and bradycardia was
statistically not significant between the two groups.
Conclusion:Tramadol was effective adjuvant to hyperbaric
bupivacaine for intrathecal use to increase the duration of
spinal anesthesia in patients undergoing lower abdominal
surgeries.