COMPARISON OF PROLONGATION OF ANALGESIA AND CONSUMPTION OF OPIOIDS IN PATIENTS GIVEN SAB WITH LOCAL ANESTHESIA ALONE VERSUS WITH TRAMADOL AS ADJUVANT THERAPY UNDERGOING LOWER LIMB SURGERY
DOI:
https://doi.org/10.54112/bcsrj.v2023i1.184Keywords:
subarachnoid block, prolongation, analgesia, tramadol, opioidsAbstract
The purpose of this study was to determine whether or not adding intrathecal tramadol to bupivacaine for lower limb procedures increased the duration of analgesia and decreased the mean post-operative opioid intake. This research was carried out between June 1 and November 30, 2022, in the Department of Anaesthesiology at Aziz Bhatti Shaheed Teaching Hospital in Gujrat, Pakistan. Non-probabilistic sequential sampling was used to pick the patients. One hundred patients from the ASA I, II, and III categories who met the inclusion criteria and were scheduled for lower limb surgery were randomly assigned to one of two groups. The tramadol-bupivacaine group (T) was given 15 milligrams of tramadol and 10 milligrams of bupivacaine (0.5 percent). In comparison, the bupivacaine-alone group (B) was given 1 milliliter of saline and 10 milligrams of bupivacaine (0.5 percent). The duration of analgesia was recorded by tracking the time until the patient first asked for pain medication. The average amount of opioid analgesia taken by both groups in the first 24 hours after surgery was also compared. SPSS version 22 was used for the data analysis. Anesthesia lasted much longer, 174.26 ± 15.21 minutes in the tramadol group, compared to 132.5 ± 14.48 minutes in the bupivacaine group. (p = 0.006). As expected, there was a significant (p 0.001) reduction in 24-hour opioid intake (308.2 ± 23.8) in group T compared to group B (470.5 ±
36.2mg). This research confirmed that intrathecal tramadol (15mg) could be safely used with bupivacaine in subarachnoid blocking to increase the duration of analgesia and reduce the need for opioids in the post-operative period following lower limb procedures.
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References
Abdulhasan, A. I., and Hassoon, S. M. (2019). A COMPARATIVE STUDY BETWEEN TRAMADOL AND FENTANYL IN SPINAL ANESTHESIA IN CESAREAN SECTION.
Afolayan, J. M., Olajumoke, T., Amadasun, F., and Edomwonyi, N. (2014). Intrathecal tramadol versus intrathecal fentanyl for visceral pain control during bupivacaine subarachnoid block for open appendicectomy. Nigerian journal of clinical practice 17, 324-330.
Alenezi, A., Yahyouche, A., and Paudyal, V. (2021). Current status of opioid epidemic in the United Kingdom and strategies for treatment optimisation in chronic pain. International journal of clinical pharmacy 43, 318-322.
Bajwa, B. S., Singh, A. P., and Rekhi, A. K. (2017). Comparison of intrathecal clonidine and fentanyl in hyperbaric bupivacaine for spinal anesthesia and post-operative analgesia in patients undergoing lower abdominal surgeries. Saudi journal of anaesthesia 11, 37.
Brijesh, J., and Sarasawat, V. (2001). Efficacy of intrathecal tramadol for post-operative pain relief in cases of LSCS and major gynecological surgeries-A clinical evaluation. Indian J Anaesth 45, 282.
Chakraborty, S., Chakrabarti, J., and Bhattacharya, D. (2008). Intrathecal tramadol added to bupivacaine as spinal anesthetic increases analgesic effect of the spinal blockade after major gynecological surgeries. Indian journal of pharmacology 40, 180.
Chatrath, V., Khetarpal, R., Sharma, S., Kumari, P., and Bali, K. (2015). Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor. Saudi journal of anaesthesia 9, 263.
Edinoff, A. N., Houk, G. M., Patil, S., Siddaiah, H. B., Kaye, A. J., Iyengar, P. S., Cornett, E. M., Imani, F., Mahmoudi, K., and Kaye, A. M. (2021). Adjuvant drugs for peripheral nerve blocks: The role of alpha-2 agonists, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs. Anesthesiology and Pain Medicine 11.
Ganjali, M. R., Larijani, B., and Pourbasheer, E. (2016). Fabrication of an all solid state (ASS) polymeric membrane sensor (PME) for tramadol and its application. Int. J. Electrochem. Sci 11, 2119-2129.
Grace, D., and Fee, J. (1995). Ineffective analgesia after extradural tramadol hydrochloride in patients undergoing total knee replacement. Anaesthesia 50, 555-558.
Honca, M., Dereli, N., Kose, E. A., Honca, T., Kutuk, S., Unal, S. S., and Horasanli, E. (2015). Low-dose levobupivacaine plus fentanyl combination for spinal anesthesia in anorectal surgery. Revista Brasileira de Anestesiologia 65, 461-465.
Hussain, A., Siddiqui, S., Sharma, M., and Madhesiya, G. (2016). Intrathecal Tramadol added to bupivacaine as spinal anesthetic increases analgesic effect of the spinal blockade after lower limb orthopedic Surgeries. Indian J Appl Res 6, 4-6.
Lawrie, C. M., Ong, A. C., Hernandez, V. H., Rosas, S., Post, Z. D., and Orozco, F. R. (2017). Incidence and risk factors for post-operative urinary retention in total hip arthroplasty performed under spinal anesthesia. The Journal of arthroplasty 32, 3748-3751.
Lirk, P., Hollmann, M. W., and Strichartz, G. (2018). The science of local anesthesia: basic research, clinical application, and future directions. Anesthesia & Analgesia 126, 1381-1392.
Malhotra, A., Singh, U., Singh, M. R., Sood, D., Grewal, A., and Mahajan, A. (2020). Efficacy of premixed versus succedent administration of fentanyl and bupivacaine in subarachnoid block for lower limb surgeries: A randomised control trial. Indian Journal of Anaesthesia 64, S175.
Mostafa, M. G., Mohamad, M. F., and Farrag, W. (2011). Which has greater analgesic effect: intrathecal nalbuphine or intrathecal tramadol. J Am Sci 7, 480-84.
Nanda, A., and Van de Velde, M. (2022). Regional anaesthesia: what surgical procedures, what blocks and availability of a "block room"? Current Opinion in Anaesthesiology 35, 698-709.
Ozcengiz, D., Gunduz, M., Ozbek, H., and Isik, G. (2001). Comparison of caudal morphine and tramadol for post-operative pain control in children undergoing inguinal herniorrhaphy. Pediatric Anesthesia 11, 459-464.
Parthasarathy, S., and Ravishankar, M. (2002). Single dose intrathecal tramadol in the management of post appendicectomy pain. J Anaesthesiol Clin Pharmacol 18, 419-22.
Prabhakar, A., Lambert, T., Kaye, R. J., Gaignard, S. M., Ragusa, J., Wheat, S., Moll, V., Cornett, E. M., Urman, R. D., and Kaye, A. D. (2019). Adjuvants in clinical regional anesthesia practice: A comprehensive review. Best Practice & Research Clinical Anaesthesiology 33, 415-423.
Sousa, A. M., and Ashmawi, H. A. (2015). Local analgesic effect of tramadol is not mediated by opioid receptors in early post-operative pain in rats. Revista Brasileira de Anestesiologia 65, 186-190.
Subramani, Y., Nagappa, M., Kumar, K., Fochesato, L.-A., Chohan, M. B. Y., Zhu, Y. F., Armstrong, K., and Singh, S. I. (2020). Effect of intrathecal lipophilic opioids on the incidence of shivering in women undergoing cesarean delivery after spinal anesthesia: a systematic review and bayesian network meta-analysis of randomized controlled trials. BMC anesthesiology 20, 1-13.
Swain, A., Nag, D. S., Sahu, S., and Samaddar, D. P. (2017). Adjuvants to local anesthetics: Current understanding and future trends. World journal of clinical cases 5, 307.
Venkata, H. G., Pasupuleti, S., Pabba, U. G., Porika, S., and Talari, G. (2015). A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section. Saudi journal of anaesthesia 9, 122.
Wilder‐Smith, C., Wilder‐Smith, O., Farschtschian, M., and Naji, P. (1998). Preoperative adjuvant epidural tramadol: the effect of different doses on post-operative analgesia and pain processing. Acta anaesthesiologica scandinavica 42, 299-305.
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