ABSTRACT
Background: Pain pathway has profound implications for management of acute pain and provoked interest in the use of pre-emptive analgesia and new methods of postoperative pain management with new agents like opioid and non-opioid drugs either independently or in combination. The objective of the study was to study efficacy of Ketamine Hcl and Tramadol Hcl (preservative free) by epidural route for lower abdominal surgeries.Methods: This study has been conducted on hundred patients in the age group of 20 to 50 years. These patients have undergone various lower abdominal surgeries, gynecological and surgical procedures. Failed epidurals, catheter kinking, catheter migration and dural puncture cases are excluded from the study. The patients were divided into two groups namely Group-A and Group-B, with 50 patients in each group.Results: Both groups were similar in terms of age, sex and weight. In Group-A patients who received 30 mg of Ketamine, the mean time of onset of analgesia being 17.01+2.65 minutes compared to 12.18+2.28 minutes in Group -B patients who received 100 mg of tramadol, In Group-A the mean time of duration of analgesia is 6.75+0.46 hours compared to 9.36+0.84 hours in Group-B. Nausea and vomiting (24% vs. 2%), urinary retention (4% vs. 2%) was more in group B compared to group A patients. Backache was equal in both the group patients (6% vs. 6%). Pain on injection more in group A patients i.e. 8% compared to only 2% in patients who belonged to group B.Conclusions: Epidural tramadol is superior to epidural ketamine for postoperative pain relief.
ABSTRACT
Background: To reduce effects associated the adverse hemodynamic effects associated with the spinal anesthesia– induced medical sympathectomy, combinations of very small doses of local anesthetic and adjuvant opioids are frequently administered. However, for elderly patients undergoing transurethral procedures, the optimal bupivacaine-fentanyl dose is unknown. The aim of the study is to find the optimal dosage of intrathecal anesthesia for elderly patients undergoing short transurethral procedures with bupivacaine–fentanyl, with stable hemodynamics. Methods: The study included 75 patients, ASA I, II and III scheduled for transurethral procedures at Kamineni hospitals, L.B. Nagar, Hyderabad which is a 350 bedded super-speciality tertiary care center. These patients were randomly allocated into three groups, 25 patients in each group. Group A received 7.5 mg bupivacaine, Group B were given 5 mg bupivacaine along with fentanyl 20 μg while patients in Group C received bupivacaine 4 mg with fentanyl 20 μg. Intrathecal fentanyl as an analgesic adjuvant to bupivacaine anesthesia. Intraoperative pain was assessed using Visual Analog Scale (VAS). Demographics, time intervals, and continuous variables (MAP, heart rate, SpO2, VAS) were analyzed using the one-way analysis of variance (ANOVA) test. Results: Demographic characteristics as well as intraoperative MAP, heart rate and SpO2 were similar among groups. Intraoperative rescue fentanyl requirements were significantly higher in group C (bupivacaine 4 mg + fentanyl 20μg) when compared with those in the other two groups. In group A (bupivacaine 7.5 mg), there was significant difference in mephenteramine requirements. Conclusion: Of the doses investigated bupivacaine 5 mg with fentanyl 20μg, provided adequate analgesia and was associated with hemodynamic stability and the fewest side effects.