Tramadol as an adjuvant to levobupivacaine in an ultrasound-guided transversus abdominis plane block in women undergoing abdominal hysterectomy

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Abstract

Objective

The aim of the current trial was to assess the value of adding tramadol to levobupivacaine in an ultrasound-guided transversus abdominis plane (TAP) block in women undergoing total abdominal hysterectomy.

Methods

The current study was a double-blind randomized-controlled trial on 66 patients scheduled for abdominal hysterectomy. Patients were divided into three equal groups, where general anesthesia was given, followed by an ultrasound-guided insertion of the needle to perform a bilateral TAP block. The women recruited were randomized as follows: group I, which included women who received a TAP block using 20 ml 0.5% levobupivacaine with 2 ml saline 0.9%, group II, which included women who received a TAP block using 2 ml (100 mg) tramadol in addition to using 20 ml 0.5% levobupivacaine; and group III, which included women who received a TAP block using 22 ml saline 0.9% (control). The mean 48-h morphine requirement, time to first rescue analgesic, total intraoperative fentanyl consumption, and number of patients who needed additional fentanyl were recorded. In addition, a visual analogue scale for assessment of pain in the postanesthesia care unit, as well as 2, 4, 6, 12, 24, and 48 h postoperatively, level of sedation, patient satisfaction, and adverse effect were recorded.

Results

Morphine requirements in the postoperative 48 h were significantly less in group II (18.1±2.4 mg) than in group I (26.1±3.3 mg) and group III (55.8±3.1 mg) (P<0.001). Furthermore, time to first rescue analgesic was significantly longer in group II (250.8±23.3 min) than the other two groups. The total intraoperative fentanyl consumption and number of patients who needed additional intraoperative fentanyl were significantly less in groups I and II compared with group III. The median postoperative pain score was significantly lower in the women in groups II and I compared with women of group III at 2, 4, and 6 h postoperatively. The differences in these outcomes between groups I and II were significant in favor of group II. The incidence of nausea, vomiting, and sedation was significantly reduced in patients of groups I and II in comparison with group III. All TAP patients reported high levels of satisfaction with their postoperative analgesic regimen than the control group. No complications attributed to the block were recorded.

Conclusion

Addition of tramadol to the local anesthetic in a TAP block significantly reduced the immediate postoperative pain, prolonged the time to first rescue analgesia, reduced the mean 48-h morphine consumption, and prolonged the duration of postoperative analgesia.

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