Intrathecal tramadol versus intrathecal fentanyl for visceral pain control during bupivacaine subarachnoid block for open appendicectomy.
BACKGROUND
Profound side-effects following intrathecal use of local anesthetics as the sole drugs of choice make spinal anesthesia for open appendicectomy uncommon.


OBJECTIVE
The aim of this study was to evaluate the effectiveness of intra-operative analgesia produced by intrathecal tramadol and fentanyl during bupivacaine spinal anesthesia for open appendicectomy.


METHODS
A prospective randomized study was performed.


METHODS
A total of 186 American Society of Anesthesiologists 1 or 11 patients scheduled for emergency open appendicectomy were analyzed. Group FB ( n = 62) received intrathecal fentanyl 25 μg plus 3 ml of 0.5% hyperbaric bupivacaine, Group SB ( n = 62) received 0.5 ml normal saline plus 3 ml of 0.5% hyperbaric bupivacaine and Group TB ( n = 62) received intrathecal tramadol 25 mg plus 3 ml of 0.5% hyperbaric bupivacaine. Visual analog scale scores and frequency of subjective symptoms among patients in the three groups formed the primary outcome measure of this study.


RESULTS
Effective intraoperative sensory block was achieved in 100% of patients in group FB and TB while 29 (46.8%) patients in group SB had ineffective sensory block ( P = 0.0001). The pain free period was significantly longer in patients in Group FB than Group SB and TB. Mean time for Group FB with regard to first analgesic request was 304.73 ± 67.91 min, Group SB was 146.59 ± 36.62 and Group TB was 238.39 ± 61.28 min. Incidence of complications were comparable among the three groups.


CONCLUSIONS
This study showed that intrathecal tramadol (25 mg) can safely replace intrathecal fentanyl (25 μg) in the management of visceral pain and discomfort during subarachnoid block for appendicectomy.
Department of Anaesthesia, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria.
J M
JM
Afolayan
T O
TO
Olajumoke
F E
FE
Amadasun
N P
NP
Edomwonyi
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000704:Analysis of Variance; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects; D001062:Appendectomy / Q000379:methods*; D002045:Bupivacaine / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007278:Injections, Spinal; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology; D008297:Male; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D059408:Pain Management / Q000379:methods; D011446:Prospective Studies; D014147:Tramadol / Q000008:administration & dosage* / Q000009:adverse effects; D059265:Visceral Pain / Q000188:drug therapy*
D000701:Analgesics, Opioid; D000777:Anesthetics; D014147:Tramadol; D005283:Fentanyl; D002045:Bupivacaine