Postoperative analgesic efficacy of epidural tramadol as adjutant to ropivacaine in adult upper abdominal surgeries

Abstract

Background:Postoperative pain control after major abdominal surgery is the prime concern of anesthesiologist. Among various methodologies, epidural analgesia is the most preferred technique because of the excellent quality of analgesia with minimum side-effects.Aim:The present study was designated to compare postoperative analgesic efficacy and safety of epidural tramadol as adjuvant to ropivacaine (0.2%) in adult upper abdominal surgery.Settings and Design:Prospective, randomized-controlled, double-blinded trial.Materials and Methods:Ninety patients planned for upper abdominal surgery under general anesthesia were randomized into three equal groups to receive epidural drug via epidural catheter at start of incisional wound closure: Group R to receive ropivacaine (0.2%); Group RT1 to receive tramadol 1 mg/kg with ropivacaine (0.2%); and RT2 to receive tramadol 2 mg/kg with ropivacaine (0.2%). Duration and quality of analgesia (visual analog scale [VAS] score), hemodynamic parameters, and adverse event were recorded and statistically analyzed.Statistical Analysis:One-way analysis of variance test, Fisher's exact test/Chi-square test, whichever appropriate. A P < 0.05 was considered significant.Results:Mean duration of analgesia after epidural bolus drug was significantly higher in Group RT2 (584 ± 58 min) when compared with RT1 (394 ± 46 min) or R Group (283 ± 35 min). VAS score was always lower in RT2 Group in comparison to other group during the study. Hemodynamic parameter remained stable in all three groups.Conclusion:We conclude that tramadol 2 mg/kg with ropivacaine (0.2%) provides more effective and longer-duration analgesia than tramadol 1 mg/kg with ropivacaine (0.2%).

Adjuvants to local anesthetics: Current understanding and future trends

“…Epidural tramadol in doses of 1-2 mg/kg presented itself as an attractive alternative to morphine for postoperative analgesia without any respiratory depressant effect[ 58 ]. Epidural tramadol has given good results for amelioration of pain in various patient subsets ranging from obstetric patients and abdominal surgeries to pediatric patients for lower abdominal procedures[ 59 - 63 ].…”

A Comparative study of epidural Fentanyl with Bupivacaine & epidural Tramadol with Bupivacaine for post operative pain relief after lower abdominal Surgery

“…Anil P. Singh et al in their study of Ninety patients undergoing abdominal surgery under general anesthesia compared ropivacaine and ropivacaine along with Tramadol 1 mg/kg and 2 mg/kg. The authors found that Tramadol 2 mg/kg with ropivacaine (0.2%) was more effective and responsible for longerduration analgesia than Tramadol 1 mg/kg with ropivacaine (0.2%) [16] .…”

Postsurgical Analgesic Efficacy of Epidural Nalbuphine in Lower Abdominal Surgeries

“…The level of significance was kept at p<0.05. Assuming the average duration of analgesia of 394 min and standard deviation of 46 min (with reference to study done by Anil P Singh (7) et al), keeping power at 80% and confidence interval at 95% (alpha error at 0.05), a sample size of 24 patients would be required to detect a minimum of 10% difference in duration of analgesia between 2 groups. We included 30 patients in each group to compensate for possible drop out.…”

“…Advantages of this combination includes effective pain relief, motor sparing. Different adjuvants like opioids (morphine, buprenorphine, fentanyl, pethidine, (6) tramadol, (7) nalbuphine, (8) ) ketamine, (9) midazolam, (10) alpha-2 adrenergic agonist (clonidine, (11) dexmedetomidine (11) ) have been used along with bupivacaine and ropivacaine with varied effects. Bupivacaine is a potent long acting amide, a local anaesthetic agent for epidural analgesia but has high chance of cardiac toxicity after accidental intravascular injection and cause motor blockade.…”