Nagpal Vishal, Rana Shelly, Singh Jai, Chaudhary Sudarshan Kumar
Department of Anaesthesia, Dr. R.P.G.M.C, Kangra, Himachal Pradesh, India.
J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):191-5. doi: 10.4103/0970-9185.155147.
The study was designed to compare the effects of tramadol administered as an adjunct to bupivacaine in supraclavicular block to that of systemic administration, on postoperative analgesia and rescue analgesic requirement following upper limb surgeries.
A prospective, randomized, controlled, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular block. All the three group patients received either of the following drugs mixtures: Group A - bupivacaine 0.5%-18 ml + normal saline-7 ml for block and normal saline-10 ml intravenously. Group B - bupivacaine 0.5%-18 ml + normal saline-7 ml mixture for block and tramadol (100 mg) diluted to 10 ml - intravenously. Group C - bupivacaine 0.5%-18 ml + tramadol (100 mg) + normal saline-5 ml mixture and normal saline 10 ml intravenously. The patients were observed for sensory, motor onset along with the duration of sensory and motor block. Patients were monitored for sedation and hemodynamic parameters during intra-operative and postoperative period. Pain-free period and demand for rescue analgesia was noted in all the patients.
The study demonstrates that the mixture of tramadol and bupivacaine injected perineurally for supraclavicular brachial plexus block hastens the onset of sensory block, motor block and provides a longer duration of motor blockade and demand for rescue analgesia as compared to other two groups.
In conclusion, the addition of tramadol to bupivacaine mixtures as an adjunct for supraclavicular brachial plexus block provide better postoperative analgesia for orthopedic upper extremity surgery in comparison to control or systemic tramadol group without any side effects.
本研究旨在比较曲马多作为布比卡因辅助药物用于锁骨上阻滞与全身给药，对上肢手术后镇痛及补救性镇痛需求的影响。
对计划在锁骨上阻滞下行上肢手术的患者进行一项前瞻性、随机、对照、双盲研究。所有三组患者均接受以下药物混合液之一：A组——0.5%布比卡因18毫升 + 生理盐水7毫升用于阻滞，静脉注射生理盐水10毫升。B组——0.5%布比卡因18毫升 + 生理盐水7毫升混合液用于阻滞，静脉注射稀释至10毫升的曲马多（100毫克）。C组——0.5%布比卡因18毫升 + 曲马多（100毫克）+ 生理盐水5毫升混合液，静脉注射生理盐水10毫升。观察患者感觉、运动起效情况以及感觉和运动阻滞持续时间。术中及术后监测患者的镇静及血流动力学参数。记录所有患者的无痛期及补救性镇痛需求。
研究表明，与其他两组相比，曲马多与布比卡因混合液经神经周围注射用于锁骨上臂丛神经阻滞可加快感觉阻滞、运动阻滞的起效，并提供更长时间的运动阻滞及更低的补救性镇痛需求。
总之，与对照组或全身应用曲马多组相比，在布比卡因混合液中添加曲马多作为锁骨上臂丛神经阻滞的辅助药物，可为骨科上肢手术提供更好的术后镇痛效果，且无任何副作用。
