Authors
Department of Anesthesiology and Intensive Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Bupivacaine, tramadol, and pethidine has local anesthetic effect. The aim of this study was to compare effect of subcutaneous (SC) infiltration of tramadol, pethidine, and bupivacaine on postoperative pain relief after cesarean delivery.
Materials and Methods: 120 patient, scheduled for elective cesarean section under spinal anesthesia, were randomly allocated to 1 of the 4 groups according to the drugs used for postoperative analgesia: Group P (Pethidine) 50 mg ,Group T (Tramadol) 40 mg, Group B (Bupivacaine 0.25%) 0.7 mg/kg, and Group C (control) 20CC normal saline injection in incision site of surgery. Pain intensity (VAS = visual analogous scale) at rest and on coughing and opioid consumption were assessed on arrival in the recovery room, and then 15, 30, 60 minutes and 2, 6, 12, 24 hours after that.
Results: VAS scores were significantly lower in groups T and P compared with groups B and C except for 24 hours (VAS rest) and 6 hours (VAS on coughing) postoperatively (P < 0.05). The number of patients requiring morphine were significantly different between the groups (105 doses vs. 87, 56, 46, doses for group C, B, T and P, respectively, P < 0.05) in all the times, except for 2 and 6 hours postoperatively.
Conclusions: The administration of subcutaneous pethidine or tramadol after cesarean section improves analgesia and has a significant morphine-sparing effect compared with bupivacaine and control groups.
Keywords
1. | McIntosh DG, Rayburn W. Patient-controlled analgesia in obstetrics and gynecology. Obstet Gynecol 1991;78:1129-35. |
2. | Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg 1985;64:715-30. |
3. | Eisenach J, Grice S, Dewan D. Patient-controlled analgesiafollowing cesarean section: A comparison with epidural and intramuscular narcotics. Anesthesiology 1988;68:444-8. |
4. | Harrison D, Sinatra R, Morgese L, Chung J. Epidural narcotic and patient-controlled analgesia for cesarean section pain relief. Anesthesiology 1988;68:454-7. |
5. | Sharma S, Sidawi E, Ramin S, Lucas M, Leveno K, Cunningham G. Cesarean delivery- A randomized trial of epidural versus patient-controlled meperidine analgesia during labour. Anesthesiology 1997;87:487-97. |
6. | Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med 1995;332:1685-90. |
7. | Heard SO, Edwards WT, Ferrari D, Hanna D, Wong PD, Liland A, et al. Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: A randomized, prospective, double-blind study. Anesth Analg 1992;74:822-6. |
8. | Picard PR, Tramer MR, McQuar HJ, Moore RA. Analgesic efficacy of peripheral opioids (all except intra-articular): A qualitative systematic review of randomized controlled trialls. Pain 1997;72:309-18. |
9. | Fukuda K. Intravenous opioid anesthetics. In: Miller RD, editor. Miller's Anesthesia. 6th edition. Philadelphia, Pennsylvania: Elsevirer Churchill Livingstons; 2005. p. 415. |
10. | Atunkaya H, Ozer Y, Kargi E, Babuccu O. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. Br J Anaesth 2003;90:320-2. |
11. | Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Hosnuter M, Demirel CB, et al. The postoperative Analgesic effet of tramadol when used as subcutaneous local Anesthetic. Anesth Analg 2004;99:1461-4. |
12. | Langlois G, Estèbe JP, Gentili ME, Kerdilès L, Mouilleron P, Ecoffey C. et al. The addition of tramadol to lidocaine does not reduce tourniquet and postoperative pain during IV regional anesthesia. Can J Anaesth 2002;49:165-8. |
13. | Pang WW, Huang PY, chang DP, Huang MH. The peripheral analgesic effect of tramadol in reducing propofol injection pain: A comparison with lidocaine. Reg Anesth Pain Med 1999;24:246-9. |
14. | Acalovschi I, Cristea T, Margarit S, Gavrus R. Tramadol added to lidocaine for intravenous regional anesthesia. Anesth Analg 2001;92:209-14. |
15. | Kapral S, Gollmann G, Waltl B, Likar R, Sladen RN, Weinstabl C, et al. Tramadol added to mepivacaine prolongs the duration of an axillary brachial plexus blockade. Anesth Analg 1999;88:853-6. |
16. | Wagner LE II, Eaton M, Sabnis SS, Gingrich KJ. Meperidine and lidocaine block of recombinant voltage-dependent Na+channels: Evidence that meperidine is a local anesthetic. Anesthesiology 1999;91:1481-90. |
17. | Jou IM, Chu KS, Chen HH, Chang PJ, Tsai YC. The effects of intrathecal tramadol on spinal somatosensory evoked potentials and motor evoked responses in rats. Anesth Analg 2003;96:783-8. |
18. | Mert T, Gunes Y, Guven M, Gunay I, Ozcengiz D. Comparison of nerve conduction blocks by an opioid and a local anesthetic. Eur J Pharmacol 2002;439:77-81. |
19. | Shipton EA. Tramadol: Present and future. Anaesth Intensive Care 2000;28:363-74. |
20. | Radbruch L, Grond S, Lehmann KA. A risk-benefit assessment of tramadol in the management of pain. Drug Saf 1996;15:8-29. |
21. | Lintz W, Beier H, Gerloff J. Bioavailability of tramadol after i.m. injection in comparison to i.v. infusion. Int J Clin Pharmacol Ther 1999;37: 175-83. |
22. | Gleeson RP, Rodwell S, Shaw R, Seligman SA. Post cesarean analgesia using a subcutaneous pethidine infusion. Int J Gynaecol Obstet 1990;33:13-7. |
23. | Zohar E, Shapiro A, Eidinov A, et al. Postcesarean analgesia: the efficacy of bupivacaine wound instillation with and without supplemental diclofenac. J Clin Anesth 2006;18:415-21. |
24. | Woolf CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth 1989;63:139-46. |
25. | Woolf CJ, Chong MS. Preemptive analgesia: Treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77:362-79. |
26. | Trotter TN, Hayes-Gregson P, Robinson S, Cole L, Coley S, Fell D. Wound in filtration of local anesthetic after lower segment caesarean section. Anaesthesia 199146:404-7. |
27. | Hopkins D, Shipton EA, Potgieter D, Van derMerwe CA, Boon J, De Wet C, et al. Comparison of tramadol and morphine via subcutaneous PCA following major orthopedic surgery. Can J Anesthesia 1998;45:436-42. |
28. | Demiraran Y, IIce Z, Kocaman B, Bozkurt P. Does tramadol wound infiltration offer an advantage over bupivacaine for postoperative analgesia in children following herniotomy? Paediatr Anaesth 2006;16:1047-50. |
29. | Matkap E, Bedirli N, Akkaya T, Gümüº H. Preincisional local infiltration of tramadol at the trocar site versus intravenous tramadol for pain control after laparoscopic cholecystectomy. J Clin Anesth 2011;23:197-201. Epub 2011 Apr 16. |
30. | Khajavi MR, Aghili SB, Moharari RS, Najafi A, Mohtaram R, Khashayar P, et al. Subcutaneous tramadol infiltration at the wound site versus intravenous administration after pyelolithotomy. Ann Pharmacother 2009;43:430-5. |
31. | Ayatollahi V, Behdad S, Hatami M, Moshtaghiun H, Baghianimoghadam B. Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: A double-blinded randomized placebo-controlled clinical trial. Croat Med J 2012;53:155-61. |
32. | Kasapoglu F, Kaya FN, Tuzemen G, Ozmen OA, Kaya A, Onart S. Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: Placebo-controlled clinical study. Int J Pediatr Otorhinolaryngol 2011;75:322-6. Epub 2010 Dec 18. |