Effects of Peritonsillar Injection of Tramadol and Adrenaline before Tonsillectomy

Zafarullah Beigh, Mudasir Ul Islam, Shakil Ahmad, Rafiq Ahmad Pampori, Zafarullah Beigh, Mudasir Ul Islam, Shakil Ahmad, Rafiq Ahmad Pampori

Abstract

Introduction: Various hemostatic and analgesic agents and techniques have been used to reduce intraoperative and postoperative hemorrhage and pain in tonsillectomy.Aims and objective; The current study aimed to compare the effect of using adrenaline plus tramadol and normal saline in maintaining hemostasis and control of pain in cold dissection tonsillectomy.

Materials and methods: This prospective randomized study was conducted over a period of 10 months in department of otorhinolaryngology state medical college Srinagar. In the current study 46 patients planed for tonsillectomy were put into two groups. 23 patients in each group. In group A patients (study group) 4ml of solution containing 1:200000 adrenaline and 2mg/kg tramadol was injected in peritonsillar space. In group B patients (control group) 4ml of normal saline was injected in peritonsillar space.

Results: It was found that the time required to achieve heamostasis and post operative pain was less in group A patients in comparison to Group B patients. There was no significant side effect or complications when adrenaline and tramadol were used.

Conclusion: Large randomized controlled studies are needed to compare tramadol plus adrenaline infiltration with other heamostatic and analgesics, but the current study indicated that Tramadol plus adrenaline infiltration could be an effective method to reduce the post operative pain , operative time and time to achieve heamostasis in tonsillectomy surgeries. Therefore the use of Tramadol plus adrenaline infiltration should be further promoted and implemented as routine use in tonsillectomy surgeries.

Keywords: Adrenaline; Heamostasis; Pain; Tonsillectomy; Tramadol.

References

    1. J Grainger, N Saravanappa, Local anaesthetic for post-tonsillectomy pain: a systematic review and meta-analysis, Clin. Otolaryngol. 33(2008):411–19.
    1. LM Broadman, RI Patel, BA Feldman, GL Sellman, G Melmoe, F Camilon, et al. The effects of peritonsillar infiltration on the reduction of intraoperative blood loss and post-tonsillectomy pain in children. Laryngoscope. 1989;99:578–81.
    1. J Achar, S Kundu. Principles of office anesthesia. Part I: infiltrative anesthesia. Am. Fam. Physician. 2002:91–4.
    1. Bolliston TA, Upton J. Infiltration with lignocaine and adrenaline in adult tonsillectomy. J. Laryngol Otolaryngol. 1980;94:1257–1259.
    1. Ginstrom R, Silvola J, Saarnivaara L. Local bupivacaine-epinephrine infiltration combined with general anesthesia for adult tonsillectomy. Acta Otolaryngol. 2005;125(9):972–5.
    1. Naja MZ, El Rajab M, Kabalan W, et al. Pre-incisional infiltration for paediatric tonsillectomy. A randomized double-blind clinical trial. Int Pediatr Otorhinolaryngol. 2005;69(10):1333–41.
    1. Bamigbade TA, Davidson C, Langford RM, Stamford JA. Action of tramadol, its enantiomers and principal, O-desmethyltramadol, on serotonin (5-HT) efflux and uptake in the rat dorsal raphe nucleus. Br. J. Anaesth. 1997;79:352–6.
    1. Jou IM, Chu KS, Chen HH, et al. The effects of intrathecal tramadol on spinal somatosensory-evoked potentials and motor evoked responses in rats. Anesth. Analg. 2003;96:783–8.
    1. Altunkaya H, Ozer Y, Kargi E, Babuccu O. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. Br. J. Anaesth. 2003;90:320–2.
    1. Atef A, Fawaz AA. Peritonsillar infiltration with tramadol improves pediatric tonsillectomy pain. Eur Arch Otorhinolaryngol. 2008;265:571–74.
    1. Altunkaya H, Ozer Y, Kargi E, Babuccu O. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. Br. J. Anaesth. 2003;90:320–2.
    1. Altunkaya H, Ozer Y, Kargi E, et al. The Postoperative Analgesic Effect of Tramadol When Used as Subcutaneous Local Anesthetic. Anesth. Analg. 2004;99:1461–4.
    1. Bamigbade TA, Davidson C, Langford RM, Stamford JA. Action of tramadol, its enantiomers and principal, O-desmethyltramadol, on serotonin (5-HT) efflux and uptake in the rat dorsal raphe nucleus. Br. J. Anaesth. 1997;79:352–6.
    1. Wagner LE II, Eaton M, Sabnis SS, Gingrich KJ. Meperidine and lidocaine block of recombinant voltage-dependent Na+ channels: evidence that meperidine is a local anesthetic. Anesthesiology. 1999;91:1481–90.
    1. Jou IM, Chu KS, Chen HH, et al. The effects of intrathecal tramadol on spinal somatosensory-evoked potentials and motor evoked responses in rats. Anesth Analg. 2003;96:783–8.
    1. Mert T, Gunes Y, Guven M, et al. Comparison of nerve conduction blocks by an opioid and a local anesthetic. Eur. J. Pharmacol. 2002;439:77–81.
    1. Akbay BK, Yilizbas S, Guclu E, Yilaz S, Iskender A, Ozturk O. Analgesic efficacy of topical tramadol in the control of postoperative pain in children after tonsillectomy. J Anesth. 2010 Oct;24(5):705–8. Epub 2010 Jun 19.
    1. Ugur MB, Yilmaz M, Altunkaya H, Cinar F, Ozer Y, Beder L. Effects of intramuscular and peritonsillar injection of tramadol before tonsillectomy: a double blind, randomized, placebo-controlled clinical trial. Int J
    1. Shipton EA. Tramadol: present and future. Anesth. Intensive Care. 2000;28:363–74.
    1. Akkaya T, Bedirli N, Ceylan T, Matkap E, et al. Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy. Eur. J. Anaesthesiol. 2009;26(4):333–7.

Source: PubMed

3
Předplatit