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EFFECT OF INTRATHECAL TRAMADOL COMBINATION WITH BUPIVACAINE FOR POST OPERATIVE PAIN RELIEF AFTER LOWER LIMB ORTHOPAEDIC SURGERY
ABSTRACT
Pain is common after most surgeries. Poorly treated or uncontrolled
postoperative pain has a lot of consequences, which include; increased
postoperative morbidity, delayed return of normal physiological function,
restriction of mobility with risk of thromboembolism and heightened
cathecolamine response leading to increased oxygen consumption.
A number of adjuncts have been used intrathecally to improve the quality
and duration of post operative analgesia. Among the opioids, tramadol which is
readily available and has less respiratory depressant effect has been used in
different doses with varying results. This study evaluated the effect of
intrathecal tramadol combination with bupivacaine for postoperative pain relief
after lower limb orthopaedic surgery.
This is a randomized double blind study. One hundred and forty-four
patients for various lower limb orthopaedic surgeries under spinal anaesthesia
who gave consent for the study were allotted to three groups (48 in each group).
Group 1(BT4O) received 40 mg of tramadol in addition to 15mg of 0.5%
hyperbaric bupivacaine for the subarachniod block, group 2(BT25) received 25
mg of tramadol plus the same dose of bupivacaine and group 3(B) received only
15mg bupivacaine. The duration of surgery, pain score (using VAS) at various
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times after the subarachnoid block up to 24 hours, and time of first analgesic
request were recorded. The number of rescue analgesic, duration of motor block,
adverse effects like sedation, nausea, vomiting hypotension, bradycardia were
also recorded.
There was no significant difference in the demographic distribution of
the patients in the groups. The time to first analgesic request, in mean and
standard deviation (duration of analgesia) among the groups were 274.34
±33.79, 241.38 ± 10.5 and190.26 ± 19.34 minutes for groups BT40, BT25, and B
respectively which was statistically significant (p =0.000).There was no
difference in the duration of motor block and duration of surgery among the
groups. There was significant difference in the number of rescue analgesia
within the next 24 hours following the subarachnoid block. The incidence of
side effects was comparable among the groups. Nausea and vomiting although
recorded in the tramadol groups were not statistically significant.
Tramadol added to bupivacaine for subarachnoid block provided post operative
analgesia after lower limb orthopaedic surgery. Tramadol 40mg provided longer
analgesia than 25mg with minimal side effects.
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