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.