Epidural Tramadol: A dose finding study to evaluate the duration of postoperative analgesia in urological surgical patients.

Abstract

Research Question: What dose of epidural tramadol provides maximum pain relief in postoperative period? Objectives: To evaluate relative efficacy of tramadol in 3 doses l mg/ kg, 2 mg/kg and 3mg/kg in providing pain relief in postoperative period in ureterolithotomy or pyelolithotomy surgical patients. Study Design & Settings: Prospective, double blind, randomized hospital based study. Material & Methods: 60 patients, ASA class I, II of either sex, age 20-60 years, scheduled for elective urological surgeries were divided into 3 groups, group I, II, III who received tramadol epidurally 1 mg/kg, 2 mg/kg and 3 mg/kg respectively. Tramadol was administered epidurally at the end of surgery in PACU, as per randomization when patients would complain of pain and VAS was more than 3. Patients were followed up to 24 hours postoperatively. Pain was assessed on the basis of visual analogue scale with ‘0’ cm - no pain and 10 cm - worst pain. Results: Mean time of first request for analgesia postoperatively was 6 hours, 14 hours and 21 hours in group I, II and III respectively. There was significant increase in postoperative nausea and vomiting in group III (40%) as compared to group I (10%) and group II (5%). Conclusions: Tramadol 2 mg/kg body weight is an optimum dose for postoperative analgesia given epidurally however 3 mg/kg body weight tramadol epidurally which gives pain relief for 21 hours can be used with appropriate antiemetic to reduce the incidence of nausea and vomiting associated with this dose