Abstract
Purpose
To compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects.
Methods
After Ethics Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L3–4 interspace in 90 ASA physical status I–II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 μg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded.
Results
Duration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001), Pain score, respiration rate, and SpO2 values were similar in all study groups.
Conclusion
We conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration.
Résumé
Objectif
Comparer ie tramadol à la combinaison de tramadol-clonidine ou de tramadol-dropéridol en regard de leurs effets analgésiques et indésirables.
Méthode
Ayant obtenu l’approbation du Comité d’éthique et le consentement éciairé des patients, nous avons réalisé l’insertion préopératoire d’un cathéter péridural dans l’espace intercostal L3–4 chez 90 patients adultes d’état physique ASA I–II devant subir une intervention abdominale basse. Lanesthésie a été normalisée. Les patients ont été répartis en trois groupes de façon aléatoire. Ceux du groupe I (T) ont reçu 75 mg de tramadol, ceux du groupe II (TD), 75 mg de tramadol et 2,5 mg de dropéridol et du groupe III (TC), 75 mg de tramadoi plus 150 μg de clonidine dans un volume total de 10 mL administré à la salle de réveil en une seule injection péridurale. Le délai d’installation et la durée de l’analgésie, la douleur selon l’échelle visuelle analogique, la sédation, les nausées, les signes vitaux et les effets secondaires ont été notés.
Résultats
La durée de l’analgésie a été comparable entre les groupes TD et TC et signifcativement plus longue que dans le groupe T (P < 0,001). Les patients du groupe TC, comparés à ceux des autres groupes, ont connu une hausse signifcative des scores de sédation et une baisse de la tension artérielle et de la fréquence cardiaque (P < 0,001). Aucun effet indésirable n’a été observé dans le groupe TD tandis que les scores de nausées ont été plus élevés dans les groupes T et TC (P < 0,001). Les scores de douleur, la fréquence respiratoire et la SpO2 ont présenté des valeurs similaires dans tous les groupes de l’étude.
Conclusion
Nous pouvons conclure que l’administration péridurale de tramadol, combinée au dropéridoi ou à la clonidine, prolonge la durée de l’analgésie; cependant, le dropéridoi semble un meilleur choix quand on considère les effets indésirables et les propriétés antiémétiques.
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Gürses, E., Sungurtekin, H., Tomatir, E. et al. The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia. Can J Anaesth 50, 147–152 (2003). https://doi.org/10.1007/BF03017847
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DOI: https://doi.org/10.1007/BF03017847