Patient-controlled extradural analgesia after caesarean section: a comparison between tramadol, sufentanil and a mixture of both.
In a double-blind randomised study into post-operative pain relief by extradural PCA, 66 Caesarean section patients were divided in to three groups to receive either sufentanil (2 µ g/ml), tramadol (10 mg/ml) or a mixture of both. After a loading dose of 10 ml, patients were allowed to ask for additional boluses of 2.5 ml, respecting a lock-out time of 10 min and a 1-h limit of 10 ml. Every 6 h, VAS pain scores, consumption of drugs, number of demands and side-effects were registered.At 6 h, pain was significantly less in the combination group compared to patients receiving tramadol alone. The 24-h dose requirements for sufentanil and tramadol when used alone were 123.5+/-10.3 µ g and 652+/-42 mg, respectively. Combining both drugs decreased the consumption and number of demands for tramadol only (22%, p<0.05 vs 18% for sufentanil, NS). In the tramadol groups, more failures and significantly more side-effects, mainly nausea and vomiting, were noticed.It may be concluded that the extradural use of tramadol is less beneficial than previously reported. Due to disturbing side-effects, relatively high dose requirements (even after the addition of a lipophilic opioid) and somewhat inferior analgesic quality, its extradural administration for postoperative pain relief cannot be recommended. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.
Vercauteren
MP
Department of Anaesthesia, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium
Mertens
E
Schols
G
Mol
IV
Adriaensen
HA