Details
Category: Volume 06 Issue 04 April 2018
Hits: 1412

Title: A Comparative study of epidural Fentanyl with Bupivacaine & epidural Tramadol with Bupivacaine for post operative pain relief after lower abdominal Surgery

Authors: Dr Sudhir Patil, Dr Abhijeet Birnale, Dr Suresh Patil, Dr Pradeep Patil

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.205

Abstract

Background: Postoperative pain control is crucial part of management of patients undergoing major abdominal surgeries. In most of the major hospital there is a gradual shift from on-demand opioid injections to epidural analgesia which is found to have excellent quality of analgesia and minimum side effects.  Fentanyl, a μ opioid agonist, when used alone has short onset of action about 5 minutes and lasting for about 3-4 hours. Tramadol hydrochloride is a weak opioid having analgesic properties. Both of these drugs fentanyl and Tramadol are used widely for epidural analgesia in patients undergoing various types of surgeries. Addition of Bupivacaine prolongs analgesic effect of Fentanyl as well as Tramadol. 

Aims And Objectives: To compare the efficacy of epidural Fentanyl with Bupivacaine and epidural Tramadol with Bupivacaine for postoperative analgesia in patients undergoing lower abdominal surgeries.

Materials and Methods: Sixty patients were included in our comparative study and they were randomly divided into two groups, Group A and B. Group A received 50 mcg Fentanyl + 8ml 0.125% Bupivacaine as a bolus dose and patients in group B received 50 mg Tramadol+ 8ml 0.125% Bupivacaine as a bolus dose. The parameters like demographic characteristics, postoperative pain and postoperative analgesia were compared in both the groups. 

Results:  Mean duration of analgesia after epidural bolus drug was significantly higher in Group A when compared with group B. Postoperative VAS score was found to be lower in Group A as compared to group B.  Hemodynamic parameter remained stable in both the groups. 

Conclusion: Epidural fentanyl along with Bupivacaine has better and prolonged postoperative analgesic effect and fewer complications as compared to Tramadol with Bupivacaine in patients undergoing lower abdominal surgeries.

Keywords:  Postoperative analgesia, Tramadol, Fentanyl, Complications.

References

  1. Garimella V, Cellini C. Postoperative Pain Control. Clinics in Colon and Rectal Surgery. 2013;26(3):191-196. 
  2. Shoar S, Esmaeili S, Safari S. Pain Management After Surgery: A Brief Review. Anesthesiology and Pain Medicine. 2012;1(3):184-186. 
  3. Seeling W, Rockemann M. [Influence of postoperative pain on morbidity and mortality.]. Schmerz. 1993 Jun;7 (2):85-96.
  4. Luo J, Min S. Postoperative pain management in the postanesthesia care unit: an update. Journal of Pain Research. 2017;10:2687-2698.
  5. Mezei M, Mihalik Z, Pénzes I. [Continuous postoperative epidural analgesia in  abdominal surgery using ropivacain]. Magy Seb. 2002 Apr;55(2):87-91.
  6. Kang XH, Bao FP, Xiong XX, Li M, Jin TT, Shao J, Zhu SM. Major complications of epidural anesthesia: a prospective study of 5083 cases at a single hospital. Acta Anaesthesiol Scand. 2014 Aug;58(7):858-66.
  7. De Leon-Casasola OA, Lema MJ. Postoperative epidural opioid analgesia: what are the choices? Anesth Analg. 1996 Oct;83(4):867-75. ‌
  8. Young JWS, Juurlink DN. Tramadol. CMAJ : Canadian Medical Association Journal. 2013;185(8):E352. 
  9. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004;43(13):879-923.
  10. Stanley TH. Fentanyl. J Pain Symptom Manage. 2005 May;29(5 Suppl):S67-71.
  11. Bauer M, George JE, Seif J, Farag E. Recent Advances in Epidural Analgesia. Anesthesiology Research and Practice. 2012;2012:309219. 
  12. Korean Knee Society. Guidelines for the Management of Postoperative Pain after Total Knee Arthroplasty. Knee Surgery & Related Research. 2012;24(4):201-207. 
  13. Chelly JE, Gebhard R, Greger J, Al Samsam T. Regional anesthesia for outpatient orthopedic surgery. Minerva Anestesiol. 2001;67:227–232
  14. Koh IJ, Kang YG, Chang CB, Do SH, Seong SC, Kim TK. Does periarticular injection have additional pain relieving effects during contemporary multimodal pain control protocols for TKA?: A randomised, controlled study. Knee  2012;19:253–259.
  15. Macintyre PE. Intravenous patient-controlled analgesia: one size does not fit all. Anesthesiol Clin North America. 2005;23:109–123.
  16. Singh AP, Singh D, Singh Y, Jain G. Postoperative analgesic efficacy of epidural tramadol as adjutant to ropivacaine in adult upper abdominal surgeries. Anesthesia, Essays and Researches. 2015;9(3):369-373. 
  17. Tan CN, Guha A, Scawn ND, Pennefather SH, Russell GN. Optimal concentration of epidural fentanyl in bupivacaine 0.1% after thoracotomy. Br J Anaesth. 2004 May;92(5):670-4. Epub 2004 Mar 19.
  18. Prakash S, Tyagi R, Gogia AR, Singh R, Prakash S. Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy. Br J Anaesth. 2006 Sep;97(3):385-8. Epub 2006 Jun 23. 
  19. Swathi N, Ashwini N, Shukla MI. Comparative study of epidural bupivacaine with butorphanol and bupivacaine with tramadol for postoperative pain relief in abdominal surgeries. Anesthesia, Essays and Researches. 2016;10(3):462-467.
  20. Delilkan AE, Vijayan R. Epidural tramadol for postoperative pain relief. Anaesthesia. 1993 Apr;48(4):328-31.

Corresponding Author

Dr Sudhir Patil

Senior Consultant Anesthetist, PIOS Multispecialty Hospital,

Jaysingpur- Sangli- Maharashtra India