title: Tramadol and levobupivacaine wound infiltration at cesarean delivery for postoperative analgesia.
abstract: OBJECTIVE
  The aim of the present study was to investigate whether levobupivacaine and tramadol wound infiltration decreases postoperative pain following Cesarean section and reduces the need for analgesics in the immediate post-delivery period.
  
  
  METHODS
  Ninety patients (aged 18-40 years) scheduled for elective Cesarean section under general anesthesia were randomly allocated to one of the three groups: the placebo group (group P) received 20 mL local wound infiltration with 0.9 % saline solution; the levobupivacaine group (group L) received 20 mL local wound infiltration with levobupivacaine 0.25 %; and the tramadol group (group T) received 20 mL local wound infiltration with 1.5 mg/kg tramadol within 0.9 % saline solution. Following the closure of the uterine incision and the rectus fascia, 20 mL solution was infiltrated subcutaneously along the skin wound edges. The primary outcome was 24-h tramadol consumption. Secondary outcomes were recorded VAS scores, diclofenac requirement, fever, vomiting, and wound infection.
  
  
  RESULTS
  At 15 min postoperatively, VAS values were lower in groups T and L than group P (P = 0.0001). The mean 24-h tramadol consumption was lowest in group T (P = 0.0001) and it was lower in the group L compared to group P (P = 0.007) (401.6, 483.3, and 557.5 mg for T, L, and P groups, respectively). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (P > 0.05).
  
  
  CONCLUSIONS
  We conclude that wound infiltration with tramadol and levobupivacaine in patients having Cesarean section under general anesthesia may be a good choice for postoperative analgesia.
authors.affiliation: Department of Anesthesiology, Duzce Faculty of Medicine, University of Duzce, Duzce, Turkey. demiryvz@yahoo.com
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Demiraran
authors.forename: Mustafa
authors.initials: M
authors.lastname: Albayrak
authors.forename: Ilknur Suidiye
authors.initials: IS
authors.lastname: Yorulmaz
authors.forename: Ismail
authors.initials: I
authors.lastname: Ozdemir
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000768:Anesthesia, General; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D002585:Cesarean Section; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D000077554:Levobupivacaine; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D014147:Tramadol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D014147:Tramadol; D000077554:Levobupivacaine; D002045:Bupivacaine