Vol. 3, Issue 2 (2017)
Comparison of Intrathecal tramadol and fentanyl as adjuvant in abdominal and lower limb surgeries: A randomized clinical study
Author(s): Sanjul Dandona, Neha Batra, Surendra Singh
Abstract: Introduction: This prospective, randomized, double-blind study compares the effect of intrathecal fentanyl-bupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries and limb surgeries. Materials and methods: Patients of either sex, aged 40 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like hydrocele, appendicectomy, inguinal hernia repair surgery and lower limb surgeries, were administered either 2.5 mL of 0.5% bupivacaine +0.5 mL (25 μg) of fentanyl citrate (group a) or 2.5 mL of 0.5% bupivacaine +0.5 mL (25 mg) of tramadol (group b) intrathecally. Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any side effects were noted at periodic intervals. Results: fifty patients were randomized to the group a (n=25) and group b (n=25). The duration of sensory blockade was significantly prolonged in group a(280.00 ± 19.88 min ) compared to group b(200 ±19. 34)Similarly, dura-tion of motor blockade was longer in group a(200.10±20.4)minutes) compared to group b(145±17.9). The total duration of analgesia was significantly prolonged (p<0.001) in group a (420±42)compared to group b(310±33.2301 minutes).Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group b patients as compared to the group a patients. The group a patients had got significantly higher sedation scores as compared to Group b patients. Conclusion: Fentanyl seems to be a better alternative to tramadol as an adjuvant to spinal bupivacaine in surgical procedures as it provides prolonged duration of the sensory block, longer duration of postoperative analgesia and lesser number of doses of rescue analgesia are required.