Local Infiltration of Tramadol versus Bupivacaine for Post Cesarean Section Pain Control: A Double-Blind Randomized Study

Mohammad Ali Sahmeddini, Simin Azemati, Ehsan Masoudi Motlagh, Mohammad Ali Sahmeddini, Simin Azemati, Ehsan Masoudi Motlagh

Abstract

Background: Postoperative pain control after cesarean section (C/S) is important because inadequate postoperative pain control can result in a prolonged hospital stay. In this study, we compared postoperative somatic wound pain control between patients receiving tramadol and bupivacaine, infiltrated at the wound site.

Methods: In this randomized clinical trial, 98 patients, eligible for elective C/S under general anesthesia, were randomly allocated to 2 groups. Before wound closure, 20 cc of 0.025% bupivacaine and 2 mg/kg of tramadol, diluted to 20 cc, were infiltrated at the wound site in groups A and B, respectively. After surgery, the pain score was measured using the visual analogue scale (VAS). Additionally, 24-hour total morphine consumption, nausea and vomiting, and respiratory depression were compared after 2, 4, 8, 16, and 24 hours between the 2 groups. The data were analyzed using SPSS with the Student independent t test, χ2 test, Fisher exact test, and repeated measure test.

Results: Postoperatively, there was no significant difference between these 2 groups in their VAS scores until 16 hours (P>0.05). However, at the 16th and 24th hours, the mean VAS scores were 3.20±2.24 and 2.51±2.55 in the bupivacaine group and 2.51±0.99 and 1.40±0.88 in the tramadol group, respectively (P<0.05). There was no difference in nausea and vomiting during the 24-hour period between the 2 groups. Also, no respiratory depression was detected in the both groups.

Conclusion: Local infiltration of tramadol (2 mg/kg) at the incision site of C/S was effective in somatic wound pain relief without significant complications.

Trial registration number: IRCT2013070111662N2.

Keywords: Bupivacaine; Cesarean section; Pain; Postoperative; Tramadol.

Figures

Figure 1
Figure 1
Shows consort flowchart of the patients according to the consort guidelines.
Figure 2
Figure 2
Shows postoperative pain intensity (VAS) in the bupivacaine and tramadol groups during the first 24 postoperative hours.

References

    1. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: Analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21:98–113. doi: 10.1111/j.1365-3016.2007.00786.x.
    1. Shoar S, Esmaeili S, Safari S. Pain management after surgery: A brief review. Anesth Pain Med. 2012;1:184–6. doi: 10.5812/kowsar.22287523.3443. [ ]
    1. McDonnell NJ, Keating ML, Muchatuta NA, Pavy TJ, Paech MJ. Analgesia after caesarean delivery. Anaesth Intensive Care. 2009;37:539–51.
    1. Verstraete S, Van de Velde M. Post-cesarean section analgesia. Acta Anaesthesiol Belg. 2012;63:147–67.
    1. Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review. Eur J Pain. 2010;14:894–ne1-9. doi: 10.1016/j.ejpain.2010.03.003.
    1. Gadsden J, Hart S, Santos AC. Post-cesarean delivery analgesia. Anesth Analg. 2005;101:S62–9. doi: 10.1213/01.ANE.0000177100.08599;.C8.
    1. Bamigboye AA, Hofmeyr GJ. Local anaesthetic wound infiltration and abdominal nerves block during caesarean section for postoperative pain relief. Cochrane Database Syst Rev. 2009;7:1–60. doi: 10.1002/14651858.CD006954.pub2.
    1. Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delivery: Systematic review and meta-analysis. Br J Anaesth. 2011;107:308–18. doi: 10.1093/bja/aer200.
    1. Kargi E, Babuccu O, Altunkaya H, Hosnuter M, Ozer Y, Babuccu B, et al. Tramadol as a local anaesthetic in tendon repair surgery of the hand. J Int Med Res. 2008;36:971–8. doi: 10.1177/147323000803600513.
    1. Jou IM, Chu KS, Chen HH, Chang PJ, Tsai YC. The effects of intrathecal tramadol on spinal somatosensory-evoked potentials and motor-evoked responses in rats. Anesth Analg. 2003;96:783–8. doi: 10.1213/01.ANE.0000049683.58980.30.
    1. Demiraran Y, Albayrak M, Yorulmaz IS, Ozdemir I. Tramadol and levobupivacaine wound infiltration at cesarean delivery for postoperative analgesia. J Anesth. 2013;27:175–9. doi: 10.1007/s00540-012-1510-7.
    1. Behdad S, Sekhavat L, Ayatollahi V, Meshkat F, Mortazavi A. Comparison of postoperative analgesic effect of tramadol and bupivacaine subcutaneous infiltration in patients undergoing cesarean section. Acta Clin Croat. 2013;52:93–7.
    1. Demiraran Y, Ilce Z, Kocaman B, Bozkurt P. Does tramadol wound infiltration offer an advantage over bupivacaine for postoperative analgesia in children following herniotomy? Paediatr Anaesth. 2006;16:1047–50. doi: 10.1111/j.1460-9592.2006.01910.x.
    1. Kaki AM, Al Marakbi W. Post-herniorrhapy infiltration of tramadol versus bupivacaine for postoperative pain relief: A randomized study. Ann Saudi Med. 2008;28:165–8. doi: 10.4103/0256-4947.51720.
    1. Akkaya T, Bedirli N, Ceylan T, Matkap E, Gulen G, Elverici O, et al. Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy. Eur J Anaesthesiol. 2009;26:333–7. doi: 10.1097/EJA.0b013e32831c8988.
    1. Matkap E, Bedirli N, Akkaya T, Gumus H. Preincisional local infiltration of tramadol at the trocar site versus intravenous tramadol for pain control after laparoscopic cholecystectomy. J Clin Anesth. 2011;23:197–201. doi: 10.1016/j.jclinane.2010.08.010.
    1. Teppema LJ, Nieuwenhuijs D, Olievier CN, Dahan A. Respiratory depression by tramadol in the cat: Involvement of opioid receptors. Anesthesiology. 2003;98:420–7. doi: 10.1097/00000542-200302000-00023.
    1. De Witte JL, Schoenmaekers B, Sessler DI, Deloof T. The analgesic efficacy of tramadol is impaired by concurrent administration of ondansetron. Anesth Analg. 2001;92:1319–21. doi: 10.1097/00000539-200105000-00045.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir