title: The effects of tramadol and levobupivacaine infiltration on postoperative analgesia in functional endoscopic sinus surgery and septorhinoplasty.
abstract: OBJECTIVE
  The aim of this prospective, randomized, double-blind study was to investigate the postoperative analgesic effects of levobupivacaine or tramadol infiltration administered prior to surgery in septorhinoplasty (SRP) or endoscopic sinus surgery (ESS).
  
  
  METHODS
  Sixty ASA class I-III adult patients electively undergoing SRP or ESC were included the study. Induction of anesthesia was performed with propofol 2-2.5 mg/kg, rocuronium bromide 0.6 mg/kg and fentanyl 1 μg/kg i.v. Sevoflurane 2% with an N2O/O2 mixture (FiO2: 35%) was used for maintenance. Tramadol 0.5 mg/kg (Group T: n=20), levobupivacaine 0.25% (Group L: n=20) and lidocaine 1% (Group C: n=20) in a 1/200,000 adrenaline solution was infiltrated into the surgical area 10 min before the operation (5 mL for ESS and 10 mL for SRP). All patients received fentanyl (bolus dose: 15 μg and lockout interval: 10 min) with a patient-controlled analgesia device during the postoperative period. Pain was assessed using an 11-point visual analogue scale (VAS) every 4 h for the first 24 h. Analgesic requirements, opioid consumption and side effects in the postoperative period were recorded.
  
  
  RESULTS
  There was a statistically significant decrease in postoperative fentanyl demand and consumption in patients receiving tramadol. Fentanyl doses in the 24 h period were 345.2±168.8 μg, 221.1±120.6 μg and 184.1±130.3 μg (p=0.002) for the Groups C, L and T, respectively. There were statistically significant differences in fentanyl requirements between the tramadol and control groups at the 16, 20 and 24 h time points (p=0.012, p=0.004 and p=0.002, respectively). The side effect profiles were similar.
  
  
  CONCLUSIONS
  Our study indicates that the preemptive tramadol infiltration technique is an efficient, practical and safe alternative to levobupivacaine in ESS or SRP operations.
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
authors.forename: Muhammet Hilmi
authors.initials: MH
authors.lastname: Koputan
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
authors.forename: Alparslan
authors.initials: A
authors.lastname: Apan
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
authors.forename: Gökşen
authors.initials: G
authors.lastname: Oz
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
authors.forename: Emine Arzu
authors.initials: EA
authors.lastname: Köse
keywords: Infiltration; levobupivacaine; patient-controlled analgesia; postoperative analgesia; tramadol