title: Efficacy of two doses of tramadol versus bupivacaine in perioperative caudal analgesia in adult hemorrhoidectomy.
abstract: BACKGROUND
  The study was conducted to evaluate the perioperative analgesic efficacy of the two doses of caudally administered tramadol versus bupivacaine in adult hemorrhoidectomy.
  
  
  METHODS
  A total of 90 patients, aged 20-50 years, undergoing hemorrhoidectomy were randomly scheduled to receive bupivacaine 0.25% in 20 ml (Group B; n = 30), tramadol 1 mg/kg in 20 ml (Group T1; n = 30), tramadol 2 mg/kg in 20 ml (Group T2; n = 30) through caudal route after induction of general anesthesia. Postoperative pain was assessed every hour until the visual analog scale was 6, which is 1(st) time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol, and epinephrine levels and incidence of side effects were also evaluated.
  
  
  RESULTS
  Duration of analgesia was longer in Group T2 (20 [1.14] h] compared with the Group B (7 [1.2] h) or Group T1 (12 [0.75] h); all P < 0.001. There were no significant hemodynamic changes. There were not incidences of side effects.
  
  
  CONCLUSIONS
  Caudal tramadol 2 mg/kg provided a longer duration of postoperative analgesia with rapid onset and no incidence of complications or adverse effects in adult hemorrhoidectomy.
authors.affiliation: Department of Anesthesia and Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt.
authors.forename: Hanan M
authors.initials: HM
authors.lastname: Farag
authors.affiliation: Department of Anesthesia and Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Esmat
keywords: Analgesia; bupivacaine; caudal; hemorrhoidectomy; tramadol