Epidural tramadol for postoperative pain relief in Cesarian section delivery

ABSTRACT

The efficacy of epidural tramadol was studied for the relief of postoperative pain in sixty patients scheduled for elective caesarian section under epidural anesthesia. A test dose of bupivacaine 0.5% was followed by the study drug using a 10 ml coded syringe group I 10 ml of 0.5% bupivacaine containing tramadol 50 mg; group II 10 ml of 0.5% bupivacaine containing tramadol 100 mg; group III 10 ml of 0.5% bupivacaine. Then, sufficient bupivacaine was administered to achieve a block up to T[4]. The study lasted for 24 h from the end of surgery. When requested by the patient, an epidural injection using a 10 ml coded syringe was given containing tramadol 50 mg [group I] or tramadol 100 mg [group II], or 0.25% bupivacaine 10 ml [group III]. A total of 4 epidural doses were allowed in the 24 h period then pain was treated by giving morphine 2 mg i.v. as needed. Time to first analgesic request was recorded. Pain scores, heart rate, blood pressure, respiratory rate and arterial blood gases were recorded postoperatively at 15 min and at 1, 4, 8, 12 and 24 h. Side effects were also recorded. Time to first analgesic request was significantly longer in group II [21.25 +/- 4.4 h] compared to group I [13.3 +/- 5.3 h] and group III [6.1 +/- 1.9 h]. Patients in tramadol 100 mg group had a significantly lower number of epidural doses. Pain scores were significantly lower in group II at 1h and 12 h when compared to group III. Mean PaO2, PaCO2 and respiratory rate did not change during the study period. The incidence of nausea and vomiting was significantly higher in group II. The difference between the mean Apgar scores in the three groups at 1 and 5 minutes was not significant epidural tramadol 100 mg can be used to provide prolonged postoperative pain relief in patients undergoing caesarian section without serious side effects to the mother or neonate. Patient can be nursed safely on a general ward basis. An anti-emetic should be routinely used to avoid nausea and vomiting