Comparative study between tramadol and pethidine when added to lidocaine for intravenous regional anesthesia

Both pethidine and tramadol have a local anesthetic effect and thus can be used for intravenous regional anesthesia [IVRA], is to compare the local anesthetic and analgesic action of lidocaine alone, tramadol added to Lidocaine and pethidine added to lidocaine in IVRA for surgeries on the upper limb. A prospective nonrandoinized case series study included 60 patients ASA physical status I and II scheduled for forearm surgery using IVRA. The patients were classified into three groups:- Lidocaine group [L]:- Included 20 patients, as a control group, and they received lidocaine hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline, Pethidine group [P]:- Included 20 patients who received Pethidine hydrochloride 100 mg [0.25%] added to lidocaine hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline and Tramadol group [T]:- Included 20 patients who received tramadol hydrochloride 100 mg [0.25%] added to lidocaine, hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline. The patients were assessed for onset and recovery of sensory and motor block, visual analogue scale [VAS]] for tourniquet and forearm pain, presence or absence of postoperative pain and time to first analgesic requirement. The onset of pinprick and touch loss was significantly shorter in pethidine and tramadol groups in comparison to lidocaine group [p <0.001], while their recovery was longer [p<0, 001 and p<0.05 respectively]. The onset of pinprick and touch loss in pethidine group was significantly shorter in comparison to tramadol group [p <0.05]. The pinprick recovery in pethidine group was significantly shorter than in tramadol group [p <0.05]. The onset of motor block in tramadol and pethidine groups was significantly shorter in comparison to lidocaine group [p <0.01, p <0.05 respectively]. There was no significant difference in the onset of motor block between tramadol and pethidine groups. The motor recovery in all three groups was comparable and the difference was [statistically non significant. For tourniquet pain VAS was significantly less at 10 min. and 20 min in the pethidine group in comparison to the lidocaine group [p<0.01 and p<0.05 respectively]. For foreann pain, VAS was significantly less in tramadol and pethidine at 10 minutes in comparison to lidocaine group [p <0.01, p < 0 001 respectively]. At 20 min there was no pain in all groups postoperative analgesic requirements The mean time to the first analgesic requirement in pethidine and tramadol groups was greater than in lidocaine group [P < 0 001]. The mean time to the first analgesic requirements in tramadol group was greater than in pethidine group [P <0.05]. Recorded side effects the incidence of tachycardia was more significant in pethidine group [40%] in comparison to the other groups. Our results suggest that, both tramadol and pethidine have a local anaesthetic effect on the peripheral nerves. Both of them enhance the speed of onset of sensory and motor block, induce better anesthesia and analgesia for tourniquet and forearm pain, improve postoperative analgesia and reduce postoperative analgesic requirements after tourniquet deflation when added to lidocaine. But tramadol is considered to be safer than pethidine

Intrathecal morphine for postoperative analgesia; comparison between three small doses in anorectal surgery

Intrathecal morphine [ITM] has a magic role in postoperative pain relief. The use of less than the optimal dose of ITM to avoid its side effects results in inadequate analgesia. To obtain the dose of intrathecal morphine which provides the best balance between analgesic efficacy and side effects in patients subjected to anorectal surgery. This control random blind study included 48 patients ASA I and II physical status scheduled for anorectal surgery under spinal anesthesia. The patients were allocated into four equal groups, all received 1 ml of 0.5% hyperbaric bupivacaine intrathecally to which is added 1 ml of 0.9% saline in the control group, 0.1 mg morphine in 1 ml of 0.9% saline in group 7, 0.2 mg morphine in 1 ml 0.9% saline in group 17 and 0.3 mg morphine in 1 ml 0.9% saline in group III. Postoperatively the patients were evaluated for any pain during the first 24 hours, rescue analgesia in the form of I.V. tenoxicam was administered on patient request. The amount of requested analgesics was recorded. The patients were followed for the incidence of pruritis and whether it requires treatment or not, postoperative nausea and vomiting [PONV], urinary retention and respiratory depression. The incidence of pain and requested analgesia was significantly less only in group III in comparison to the control group and group I. Although there was no significance difference in the dose of rescue analgesia between the 4 groups, the number of patients experienced pain after the maximal dose of tenoxicam decreased nonsignificantly from the control group [8 patients] to 4 patients in group I and significantly to 2 and 0 patients in groups II, III respectively. The incidence of pruritus was more significant only in groups II and III in comparison to the control group and group I. Pruritus required treatment only in one patient in each of group II and III with no significant difference between the four groups. There was no significant difference in the incidence of PONV and urinary retention between the four groups. There was no evidence of respiratory depression in the four groups. 0.3 mg ITM in conjunction with 20-40 mg tenoxicam provides excellent analgesia for 24 hours in anorectal surgery with minimal side effects