Comparison of Lignocaine 1.5% Alone and Lignocaine 1.5% with Tramadol for Post Operative Epidural Analgesia (original) (raw)
Related papers
Journal of Anaesthesiology Clinical Pharmacology, 2010
Epidural anesthesia provides prolonged postoperative analgesia as safer alternative to general anesthesia. Postoperative analgesia eases patient suffering, decreases cardiovascular and respiratory complications and ensures early mobilization. Despite disadvantages like hypotension, migration of epidural catheter into intravenous or subarachnoid space, epidural analgesia is an effective method of analgesia. Adjuvant like clonidine 1 , opioids 2-6 and epinephrine 4, 7, 8 has been added to improve analgesia, to reduce morbidity and to reduce local anesthetic dose and side effects. More recently, epidural administration of cholinesterase inhibitor, neostigmine, as adjuvant has been suggested to produce analgesia 9-12. The rationale behind the use of neostigmine is that acetylcholine is one of more than 25 neurotransmitters that participate in spinal cord modulation of pain processing 13. Therefore, the use of epidural neostigmine with lignocaine was investigated with respect to its specific antinociceptive activity, sedation and any potential side-effects in post operative period. PATIENTS AND METHODS This double blind, prospective and randomized study was conducted during June 2006 to August 2007 after approval of institutional ethical review committee board on 90 female ASA grade I and II patients, aged (18-45 years), scheduled to undergo lower intra abdominal surgeries. Informed written consent was taken from patient or patient's kins. Patients with contraindication to epidural anesthesia, allergy to local anesthetics and pregnant females were excluded from this study. Patients were divided into following groups of 30 each, according to the epidural medication, they received: Group I: lignocaine 1% 9ml+normal saline (NS) 1 ml. Group II: lignocaine 1% 9ml+neostigmine 100µg in NS 1ml Group III: lignocaine 1% 9ml+neostigmine 200μg in NS 1ml In operating room after intravenous access and application of monitors, epidural catheterization was performed under strict aseptic conditions, at L2-L3 or L3-L4 interspace in sitting position. A Test dose in the form of 3mL injection of lignocaine (2%) and epinephrine (1:200,000) was ABSTRACT Background: Adjuvants have been used to prolong analgesic effects of epidural local anaesthetics. We studied two different doses of neostigmine. Patients & Methods: A randomized double blind study was conducted on ninety adult females scheduled for lower intra abdominal surgeries. The study was designed to compare two doses of epidural neostigmine co administered with lignocaine, with regard to its analgesic efficacy and its effect on sedation in postoperative period. Patients were divided into three groups of 30 each. Group I received lignocaine 1% (9ml) with normal saline (1ml), group II lignocaine1% (9ml) with neostigmine 100µg in saline (1ml) and group III received lignocaine 1% (9ml) with neostigmine 200µg in NS (1ml). Group I served as a control. In operating room, after putting epidural catheter, general anesthesia was administered with propofol (2mg kg-1), succinylcholine (2mg kg-1) and maintained with O2, N2O, relaxant technique. At the end of surgery, patients were reversed. Epidural analgesic medication was administered to after proper recovery from anesthesia. Intensity of pain relief on VAS, duration of analgesia, level of sensory block, motor blockade, sedation by sedation score and complications were assessed. Results: The addition of neostigmine resulted in significant longer duration of analgesia (dose independent) and sedation (dose dependent). Sensory and motor blockade were identical in all three groups. There was no incidence of respiratory depression, pruritus, bradycardia or hypotension in any group. Two patients in control group and one, receiving neostigmine (200µg), developed nausea/vomiting. Conclusion: Co administration of epidural neostigmine and lignocaine appears to be a useful technique for postoperative analgesia as it increases the duration of analgesia and provides desirable sedation at the same time.
A comparison of epidural tramadol and epidural morphine for postoperative analgesia
Canadian Journal of Anaesthesia, 1993
The present study compared epidural tramadol with epidural morphine for postoperative analgesia in 20 patients undergoing major abdominal surgery. Intraoperatively, the patients were anaesthetized by a balanced technique of general anaesthesia combined with lumbar epidural lidocaine. In ten of the patients 100 mg tramadol diluted in 10 ml normal saline was also injected epidurally, while 4 mg epidural morphine was used in the other ten patients. In all patients, the visual analogue pain score, PaO 2, PaC02 and respiratory rate were monitored every hour for the first 24 hr postoperatively. In both the trarnadol and morphine groups, the mean hourly pain scores ranged from 0.2 + 0.6 to 1.4 5:2.5 throughout the period of observations, However, the mean Pa02 was decreased postoperatively in the epidural morphine group, while no change was observed in the epidural tramadol group. The maximal decrease of Pa02 in the epidural morphine group was observed at the tenth hour postoperatively, when it decreased to 72.8 q-10.3 mmHg. This was not associated with any increase in PaCO 2 or a decrease of respiratory rate, suggesting that hypoxaemia rather than hypercarbia or decreased respiratory rate may be an earlier indicator of respiratory depression in patients breathing room air without oxygen supplementation. The absence of clinically relevant respiratory depression following epidural tramadol compared with epidural morphine may be attributed to the different mechanisms of their analgesic action. The results suggest that epidural tramadol can be used to provide prolonged postoperative analgesia without serious side effects.
Tramadol as an adjuvant to intravenous regional anesthesia with lignocaine
Saudi medical journal, 2008
To assess the effect of different doses of tramadol when added to lignocaine during intravenous regional anesthesia (IVRA). Sixty patients, scheduled for hand surgery under IVRA in King Fahd University Hospital, Al-Khobar, Saudi Arabia from January 2006 to January 2007 were randomly allocated into 3 groups (20 patients each) in a double blind controlled study. All patients received 0.5% lignocaine, 40ml plus 2ml of a study solution containing either isotonic saline control group, or tramadol 50mg (group T50) or tramadol 100 mg (group T100). Hemodynamic changes, sensory and motor block onset and recovery times, tourniquet tolerance time, the quality of intraoperative anesthesia and the duration of postoperative analgesia were assessed. All patients, 20 in each group completed the study period. Patients who received tramadol had earlier onset of sensory block (5.2 +/= 1.2; 4.9 +/= 1.2 min in the T50; and T100 groups) compared with the control group (7.6 +/= 1.4 min). Patients who rece...
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Post-operative analgesia in patients undergoing lower abdominal surgery is very essential for immediate postoperative pain relief which can be provided by oral or parenteral medication, epidural analgesia, local blocks etc. The combined spinal–epidural technique (CSE) has become increasingly popular in recent years. The study was designed to evaluate the efficacy of epidural butorphanol and tramadol for postoperative pain relief. After the surgical procedure and regression of spinal analgesia, the epidural catheter can be used to provide postoperative pain relief. Materials and Methods: After permission from hospital ethics committee, study was conducted on 60 patients undergoing lower abdominal surgeries. Combined spinal epidural anaesthesia was planned in all these 60 patients using two segment technique.18 G epidural catheter was placed in L2-L3 space and spinal anaesthesia was given at L3-L4 space using 26 G Quincke’s needle and 0.5% bupivacaine 3ml.Sensory, motor block and hemodynamic parameters were monitored intraoperatively. Postoperatively along with hemodynamic parameters visual analogue score (VAS) was observed and at VAS > 4, study drug (either butorphanol 1mg or tramadol 50mg) was given through epidural catheter. Onset of analgesia, quality of analgesia, duration of analgesia, cardio-respiratory parameters and any side effects were monitored and documented. Statistical Analysis: Data analysis was done using the SPSS (Statistical Package for the Social Science) Version 17 for window. Discussion: Mean onset of analgesia in Butorphanol group (10.03 ± 1.85 min) was significantly faster than Tramadol group (12.17 ± 2.19 min) [Z = 4.07, p<0 Z=23.06,> Conclusion: Epidural butorphanol provides a rapid, excellent but shorter duration of analgesia when compared to epidural tramadol. Keywords: Butorphanol, Tramadol, Postoperative analgesia, Epidural analgesia.
Post-operative Epidural Analgesia with Ropivacaine and Tramadol in Lower Abdominal Surgery
Background: Post-operative pain is a major concern for patients undergoing surgery. The fear of pain keeps on preying on their minds leading to various stress related dysfunctions. The present study was designed to compare the efficacy and safety of two combinations of Ropivacaine & Tramadol in preventing post-operative pain in patients undergoing lower abdominal surgery. Patients and Methods: 60 ASA I and II patients undergoing lower abdominal surgery were randomly assigned to two groups of thirty patients each, receiving either 50mg Tramadol with 0.2% Ropivacaine (Group A) or 100mg Tramadol with 0.2% Ropivacaine (Group B) epidurally. Total volume injected was 10ml in each case. Epidural top-ups were given every 8 hourly for post-operative analgesia till 48 hrs after surgery. VAS was used to assess analgesia. Results: Demographic data and baseline parameters were comparable in both the groups. Better analgesia, as seen by lower VAS scores, was observed in Group B. Side-effects were similar in both the groups. Conclusion: 100mg Tramadol as an adjuvant to Ropivacaine 0.2% provides better analgesia as compared to 50mg Tramadol, without significant side-effects.
https://www.ijrrjournal.com/IJRR\_Vol.3\_Issue.5\_May2016/Abstract\_IJRR007.html, 2016
Background & Objective: Postoperative pain relief is a major concern for reducing postoperative morbidity. Patient controlled analgesia is a better technique for pain relief and for avoidance of drug overdosing and abuse. Patient-controlled analgesia (PCA) is commonly assumed to imply on-demand, intermittent, IV administration of opioids under patient control (with or without a continuous background infusion). Tramadol and nalbuphine are two potent analgesic drugs with different mechanism of action in the central nervous system. Tramadol is a weak opioid agonist and is used in mild to moderate pain relief. Nalbuphine is a newer opioid drug with antagonism at μ receptor and agonism at κ receptor. The aim of this study was to compare the analgesic efficacy and side effects of these two drugs in PCA for postoperative pain relief. Method: 80 patients ASA I and II, 40 patients in each group undergoing major abdominal surgery under general anaesthesia were allocated in these randomized, controlled, double blind study. They received either 10 mg tramadol or 2mg nalbuphine through PCA pump at complaint of pain. Pain assessment was done with visual analogue scale (VAS). Pain and sedation assessment was done at 30min, 3hrs, 6hrs, 15hrs, 18hrs, 21hrs, and 24hrs in postoperative period. Adverse effects and time of its occurrence, hemodynamic parameters, and respiratory rate were assessed for 24hrs. Vital parameters were monitored hourly for 24 hours. Result: VAS score decreased with time in both groups. Mean VAS score at starting of PCA was 5±0.75 in Tramadol group and 4.775±0.69 in Nalbuphine group. The difference was not statistically significant. (p>0.05).After 30 mins mean VAS score was 3.8±0.79 in Tramadol group and 2.95±0.64 in Nalbuphine group. Both groups VAS score decreased with time but more in Nalbuphine group. The difference was statistically significant (p<0.05). Sedation score decreased throughout the study period. But mean sedation score was significantly more in nalbuphine group. Nausea was observed in 15% and 4% respectively in Tramadol group and Nalbuphine group. Vomiting was observed in 6% and 0% patients respectively in Tramadol group and Nalbuphine group. No other side effects were seen. The comparison of side effects between the two groups was statistically significant.(p<0.05). Conclusion: I.V. Nalbuphine bolus administered through PCA is better for postoperative pain management after major abdominal surgery.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND In the present study, we compared the analgesic effect between buprenorphine hydrochloride and tramadol hydrochloride administered through epidural route for the purpose of postoperative analgesia in patients undergoing lower abdominal surgica l procedures. The aim of this study is to evaluate and compare the efficacy between epidurally administered buprenorphine and tramadol in providing post-operative analgesia, along with their onset and duration of analgesia, side effects. MATERIALS AND METHODS Our study included 100 patients belonging to ASA I and ASA II who came for elective lower abdominal surgeries, (Gynaecological and general surgical procedures), who were randomly divided into two groups comprising of 50 each. Two groups designated as Group A receiving Inj. Tramadol hydrochloride 50 mg and Group B receiving Inj. Buprenorphine hydrochloride 100 micrograms via epidural route (epidural catheterisation done). Patients in both groups were followed up till 24 hours post-surgery. VAS (Visual Analogue Score) score for pain intensity, onset and duration of analgesia, vital signs and side effects were monitored at 0, 15, 30 minutes and 1, 2, 3, 6, 8, 10, 12, 24 hours respectively in the postoperative period. RESULTS The onset of analgesia was faster in Group A; however, the duration of analgesia was shorter as compared to Group B. The mean onset of analgesia in Group A was found to be 9.85 ± 3.75 minutes while in Group B, it was found to be 15.71 ± 5.85 minutes. The mean duration of postoperative analgesia was found to be 359.02 ± 83.85 (SD) minutes in Group A while in Group B it was 547.52 ± 94.22 (SD) minutes, p value <0.0001 which is considered extremely significant. The pain score (VAS score), was also better (Less than 3) in Group B. During the entire study period, all the patients remained haemodynamically stable and major adverse effect like respiratory depression was not observed. However, the incidence of nausea, vomiting, pruritus, hypotension was observed in Group B more as compared to Group A. CONCLUSION At the end of the study, we came to the conclusion that epidural buprenorphine provides comparatively longer and better quality of analgesia as compared to epidural tramadol. The appreciable side effects found with injection buprenorphine were nausea, vomiting, pruritus which could be subsided by administration of antiemetics and antihistaminics respectively.
Acta Anaesthesiologica Scandinavica, 1998
Background: Tramadol is an analgesic with combined opioid agonist and monoamine reuptake blocker properties, which may be useful as a perioperative analgesic and antinociceptive adjuvant. Methods: The dose-dependent effects of adjuvant preoperative epidural tramadol on postoperative analgesia (pain scores and patient-controlled analgesia (PCA) use) and pain processing (heat pain thresholds) were prospectively studied in a doubleblind, randomised, placebo-controlled 5-day trial. Forty patients undergoing knee or hip surgery received anaesthesia with epidural lidocaine and epidural tramadol 20, 50 or 100 mg or placebo as a preoperative adjuvant. Postoperative analgesia was by intravenous PCA tramadol in all patients. Results: Postoperative pain scores were similar in all groups. The time to first PCA use was shorter, the total dose and duration of PCA use greater, and side-effects more common with 20 mg tramadol than with 100 mg or placebo (W0.05). There were no differences in PCA doses required or side-effects be-tween the tramado1100 mg and placebo treatment groups. Heat pain tolerance thresholds were increased with 100 mg tramadol at 48 h postoperatively compared to baseline and placebo (P= Conclusions: Preoperative adjuvant epidural tramadol does not improve postoperative analgesia after lidocaine epidural anaesthesia compared to placebo. Tramado120 mg results in anti-analgesia and increased side-effects. While tramadol 100 mg depresses postoperative pain-processing, as measured by heat pain tolerance thresholds, this is not reflected in improved clinical pain measures. 0.01).