Infiltration with tramadol [1-5%] in comparison with lidocaine [1%] for minor surgery

Previous studies have shown that intradcrrnal tramadol 5% can provide a local anesthetic effect similar to prilocaine 2%. The aim of our study was to determine the most effective local anesthetic concentration of tramadol hydrochloride [1, 3, or 5%] without adverse effects compared with lidocaine 1%. Eighty adult patients scheduled for excision of cutaneous lesion under local anesthesia were randomly divided into four groups. The patients were assigned to receive intradermally either 1 ml of tramadol 1% [group I, n=20], lml of tramadol 3% [group II, n=20], 1 ml of tramadol 5% [group III, n=20] and 1 ml of lidocaine 1% [group IV, n=20]. The degree of sensory block to pin prick, light touch and cold were assessed after I minute of drug administration. Pain to surgical incision was evaluated by the patients using four point scale [0-3]. Local or systemic adverse effects of the drugs were recorded. There is no significant difference as regard to quality of the block between group III and IV in comparison to group I and II [tramadol 1-3%] fail to produce local anesthetic effect similar to that in group III and IV. There is increased incidence of local reaction [rash] in group III [five patients] when compared with group IV [one patient] P<0.05. Five patients complained of burning at site of injection in group III in comparison to three patients in group IV [P>0.05]. We conclude that intradermal tramadol 5% can produce a local anesthesia similar to lidocaine 1% but with high incidence of local adverse effect

Effect of laparoscopy on hepatic function

To asses the effects of laparoscopic surgery on liver function, plasma concentration of alcoholic dehydrogenase [AD] and glutathione s- transferase [GST] was measured, which are highly concentrated into centrilobular acinus of liver and are sensitive enzymes of hepatic hypoperfusion and hepatocellular damage. Fifty patients underwent laparoscopic cholecystectomy [group A, n=25] or laparoscopic hysterectomy [group B, n=25] were studied. Perioperative AD, GST, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] in both groups was compared. Although the duration of pneumoperitoneum was longer in laparoscopic hysterectomy there was significant postoperative increase in AD and GST in the laparoscopic cholecystectomy group at the end of procedure and 1 hour after surgery compared with the laparoscopic hysterectomy group. AST and ALT concentration were significantly higher in first postoperative day in the laparoscopic cholecystectomy group than in the laparoscopic hysterectomy group. These results indicated that patient position and surgical manipulation of the liver affect significantly hepatic perfusion