Tramadol-bupivacaine versus ketamine-bupivacaine to improve epidural anaesthesia

ABSTRACT

The study included 45 patients undergoing lower ureteric surgery. The patients were allocated randomly to three equal groups to receive epidural injection of 0.5% bupivacaine [18 ml] with tramadol 100 mg, 0.5% bupivacaine [18 ml] with ketamine 40 mg in 2 ml saline or 0.5% bupivacaine [18 ml] plus 2 ml saline. Onset, duration and quality of anaesthesia, haemodynamic variables, postoperative analgesic requirements and side effects were recorded. The tramadol group recorded the most rapid onset, the most prolonged duration and the highest quality of anaesthesia. It also, provided significantly more prolonged postoperative analgesia when compared with the ketamine and the bupivacaine groups. The ketamine group provided better quality, more rapid onset and longer duration of anaesthesia compared with the bupivacaine group with more prolonged postoperative analgesia.But, it was also associated with some adverse effects as hallucinations which limits its epidural application. The results suggest that the addition of tramadol to epidural bupivacaine can significantly improve the quality of anaesthesia with significant prolongation of the postoperative analgesia without serious side effects