Intrathecal tramadol may cause respiratory depression

Opioids such as morphine and fentanyl have been used in neuraxial anesthesia to prolong the analgesic effects since long, but these have frequently been associated with few adverse effects e.g. nausea, vomiting, pruritus and rarely respiratory depression. Tramadol has also been used in epidural as well as spinal anesthesia, and respiratory depression has not been reported with its intrathecal use. We present a case in which 20 mg of intrathecal tramadol produced signs of opioid overdose including respiratory depression. The side effects were reversed with naloxone confirming our suspicion that these were caused by tramadol. We recommend adequate monitoring and vigilance for tramadol as is used for other intrathecal opioids

Peri-anal surgery under saddle block anaesthesia comparing three different doses of hyperbaric 0.75% bupivacaine

Objective: To compare three doses of hyperbaric 0.75% bupivacaine and measuring time for home readiness after day care perianal surgery under saddle block anaesthesia

Study Design: Non randomized controlled trial

Place and Duration of Study: The study was conducted at the department of Anaesthesia, CMH Rawalpindi from Jun 2014 to Apr 2015

Material and Methods: In this study 90 patients who presented for perianal day care surgery, were divided in three equal groups. Group A received 7.5 mg, group B 6.0 mg and group C 4.5 mg of hyperbaric 0.75% bupivacaine. Intrathecal injection was given in L4-5 space by 25 G spinal needle in sitting position. Lithotomy position was made after five minutes. After surgery patients were monitored in recovery room. After fulfilling ambulatory and discharge criteria patients were allowed to go home with attendants. Time of intrathecal injection, assessment of above criteria and time of discharge were noted and analyzed

Results: Male patients were 85.6% and females were 14.4%. Mean time of surgery was 48 +/- 10.59 min. Mean time of discharge in minutes for group A was 235.86 +/- 49.38, for group B 217.7 +/- 42.49 and for group C 205.76 +/- 32

Time of discharge was significantly different between group A and group C [p=0.02]

While it was not significantly different between group A and group B [p=0.29] and between group B and group C [p=0.819]

Conclusion: Lower dose of hyperbaric bupivacaine can reduce the time for home readiness compared to higher dose. Time of discharge is mainly dependent on time to micturate after saddle block anaesthesia