BACKGROUND Propofol is a commonly used anaesthetic agent for induction and maintenance of anaesthesia. Its intravenous administration is associated with pain, which is reduced by different pharmacological methods. Our study evaluated comparative effectiveness of ondansetron and tramadol in reducing this pain. MATERIALS AND METHODSAfter approval by the Institutional Ethical Committee and an informed written consent, 120 American Society of Anaesthesiologist (ASA) Grade I and II patients of either sex, aged 18 -60 years, undergoing various surgeries using general anaesthesia were selected. Patients with known hypersensitivity to propofol, ondansetron and tramadol, cardiac conduction defects and epilepsy were excluded. In our study, patients were randomly assigned to three groups of 40 patients each (Group 1, n= 40): Patients received upto 2 mL pre-treatment 50 mg tramadol in the saline, (Group 2, n= 40): 4 mg ondansetron in the saline (2 mL), (Group 3, n= 40): normal saline 2 mL. Drugs were given intravenously for a period of 10 seconds, while the venous drainage was occluded by placing an air-filled tourniquet (pressure inflated to 70 mmHg) on the upper arm by an assistant for one minute. Then patient was given intravenous propofol (1%) 2 mg/kg over a period of 10 seconds. The patient was asked a standard question "Is the injection comfortable?" The verbal response and behavioural signs such as facial grimacing, arms withdrawal or tears were recorded. A score of 0 to 3 corresponding to 0= No pain, 1= Mild pain, 2= Moderate pain and 3= Severe pain will be noted. RESULTSThe overall incidence of pain was 85% in the saline group, which was decreased to 12.5% and 20% after tramadol and ondansetron pre-treatment respectively. Pain severity was significantly less in patients receiving drugs for pre-treatment than those receiving saline (p < 0.0001). No significant association was found between gender and incidence and severity of pain (p= 0.70). The incidence and severity of pain in patients above 50 years old was significantly less than patients below 50 years old (0.0001). CONCLUSIONTramadol and ondansetron pre-treatment provides a simple and safe method of reducing propofol injection pain. Both are equally effective, but ondansetron has an advantage in preventing postoperative nausea and vomiting. KEYWORDS Propofol, Ondansetron, Tourniquet. HOW TO CITE THIS ARTICLE: Manzoor S, Malla MS, Sofi AA, et al. A study of comparison between tramadol and ondansetron to alleviate pain during propofol administration. J. Evolution Med. Dent. Sci. 2018;7(02):242-245, DOI: 10.14260/jemds/2018/54 BACKGROUND Propofol is a popular anaesthetic intravenous agent, especially for brief cases, day surgery or when laryngeal mask airway is to be used. Propofol can also be used in total intravenous anaesthesia (TIVA) technique for the maintenance of anaesthesia and sedation. It has also been used for the prevention of emesis. (1) Tracheal intubation without neuromuscular blocking agents (2) and the treatment of pruritus. (3,4) Propof...

ABASTRACT: BACKGROUND AND OBJECTIVE:Propofol is the most common induction agent for LMA insertion. Sodium thiopentone alone doesn't suppress airway reflexes adequately. So this study was designed to assess whether application of topical lignocaine prior to sodium thiopentone administration would produce LMA insertion conditions as good as propofol. METHODS: one hundred patients of either sex in the age range of 16-60 years belonging to ASAI/II scheduled for open cholycystectomy were selected and allocated into one of the two groups. All patients received fentanyl intravenously 3minutes before induction. Group IP received propofol 2.5mg/kg while as Group IIT received topical lignocaine and intravenous sodium thiopentone. Insertion conditions for Proseal LMA like gagging, coughing and laryngospasm were compared between the two groups. Duration of apnoea was also compared between two groups. RESULTS: There was no difference between two groups in gagging, coughing, laryngospasm. Number of attempts of Proseal LMA insertion and oxygen saturation were same between the two groups but the duration of apnoea was more in propofol than in topical lignocaine and sodium thiopentone group. CONCLUSION: Topical lignocaine and sodium thiopentone provided same insertion conditions for Proseal LMA as provided by propofol.

AIMS:In this study, we compared the effect of preloading with crystalloid, colloid and intravenous ephedrine against the hypotensive effects of propofol induction in ASA I-II patients scheduled for elective surgical procedures. MATERIAL AND METHODS: 120 patients aged 20yrs to 50yrs were randomly allocated to one of the four groups of 30patients each. Group-1 (control) did not receive any study medication, group-2 received degraded gelatin 10ml/kg over a period of 15min, group-3 received ringer lactate 20ml/kg over a period of 15 min and group-4 received intravenous ephedrine 0.2mg/kg prior to induction of anesthesia. Midazolam 1mg was given 1hour before induction of anesthesia. Anesthesia was induced with propofol 2.5mg/kg over 20 to 30 seconds. Heart rate and blood pressure were recorded before induction and then every minute for 5 minutes after induction of anesthesia. After the study period patients were intubated and anesthesia was continued as required. Hypotension was defined as a drop in systolic arterial pressure more than or equal to 20% of baseline. RESULTS: A significant decrease in systolic arterial pressure occurred in patients of group preloaded with ringer lactate as well as the control group. Less decrease in systolic arterial pressure was seen in the patients preloaded with degraded gelatine and ephedrine group. The incidence of hypotension was also lower in ephedrine group when compared with degraded gelatin group. CONCLUSION: We conclude that crystalloid preloading is not efficacious in preventing hypotension while as degraded gelatine and ephedrine markedly attenuates, but does not fully abolish the decrease in blood pressure caused by induction.

Background: Total abdominal hysterectomy (TAH) is a major surgical procedure associated with significant post-operative pain and discomfort. Ultrasound-guided (USG) quadratus lumborum (QL) and transversus abdominis plane (TAP) block are regional analgesic techniques that have role in post-operative pain management after TAH. Aims and Objectives: This study aims to compare quality of post-operative analgesia and analgesic consumption in USG-guided QL block and TAP block in patients undergoing TAH under spinal anesthesia. Materials and Methods: Hundred patients scheduled for TAH were observed over a period of 2 years. The patients who had received either TAP block or QL block were assigned in two groups. Patients who received TAP block after spinal anesthesia were labeled as Group A and patients who received QL block after spinal anesthesia were labeled as Group B. Postoperatively, VAS score, rescue analgesia, analgesic consumption, and hemodynamic parameters were observed at 0, 1, 3 6, 9, 12, 18, 24, and 48 h. Statistical Analysis: Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. P<0.05 was considered statistically significant. Results: Time for rescue analgesic requirement was higher in the Group B than the Group A (mean±SD: 16.5±3.096 h vs. 8.5±1.998 h) (P<0.001). Group B had significantly less analgesic demand (P<0.001) at 12, 24, and 48 h postoperatively. The VAS at rest and movement was significantly reduced in Group B at all times. Hemodynamic parameters and post-operative side effects between two groups remained insignificant. Conclusion: USG-guided quadratus lumber block provided prolonged analgesia as compared to TAP block in patients undergoing TAH after spinal anesthesia. USG-guided quadratus lumber block provides better multimodal post-operative analgesia relief in patients.

Background: Ultrasound guided transvers abdominis plane (TAP) block is a recent modality of managing postoperative pain in lower abdominal surgeries. Aims and Objective: This study was carried out to evaluate postoperative analgesic effectiveness and opioid sparing effect of ultrasound guided transverse abdominis plane block in total abdominal hysterectomy. Materials and Methods: One hundred patients of age group 25 to 65 years enrolled for total abdominal hysterectomy under general anesthesia were studied in the postoperative period at Lal Ded Hospital, Government Medical College, Srinagar over a period of 18 months. Patients who received injection Ropivacaine by ultrasound guided TAP were kept in Group A and others who received only conventional analgesia were kept in Group B. Postoperative pain scores were assessed by VAS score at 1,2,3,4,5,6,12,18 and 24 hours. Time of first rescue analgesia, total opioid consumption and postoperative adverse events were also observed. Results: Postoperative VAS pain scores were significantly reduced at all time intervals in TAP bock group (Group A) when compared with conventional analgesia group (Group B). Mean time for first rescue analgesia was 377 min in Group A as compared to 169 minutes Group B and the difference was statistically significant (p<0.05). The mean opioid consumption in Group A was 104±4.38 mg and in Group B it was 324±26.15mg and the difference between the two was statistically significant (p<0.05). Postoperative adverse events were insignificant. Conclusion: Ultrasound guided TAP block provides effective postoperative analgesia and reduces opioid consumption in abdominal hysterectomy patients under general anesthesia.