COMPARE EFFECTIVENESS OF EPIDURAL BUPIVACAINE WITH TRAMADOL & ROPIVACAINE WITH TRAMADOL IN CASES OF INTRA ABDOMINAL SURGERIES FOR PROVIDING POST OPERATIVE ANALGESIA.
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Keywords
Bupivacaine, Ropivacaine, Tramadol, General anesthesia with central neuraxial blockade, Epidural anesthesia and analgesia, Post operative analgesia
Abstract
Central neuraxial blockade in form of epidural anesthesia is considered as a good technique to provide complete and dynamic anesthesia. Its benefit include suppression of stress response by sympatholysis, stable Hemodynamic's with reduction in cardiac morbidity, reduction in pulmonary compression due to its allowance for active physiotherapy, early mobilization, reduced blood loss and decrease in thromboembolic complication following surgery . It also avoids thin disadvantage associated with general anesthesia such as airway manipulation, poly-pharmacy, etc.
Epidural analgesia is often used with General anesthesia for surgical procedure in patient of all ages with moderate to severe comorbid disease. Use of epidural anesthesia technique using local anesthetic agent along with adjuvant drugs gaining popularity due to better success rate, patient satisfaction, faster recovery.
Aim: of this study is to study efficacy and safety of Bupivacaine and Ropivacaine with tramadol in providing analgesia, duration of analgesia, any side effect or complication following administration & any hemodynamic instability following administration.
Materials and methods: Comparative observation study was carried out in 60 patients between age of 18-75 years of age, A,SA grade 1/2 undergoing abdominal surgeries.
Randomly two groups :
1.Received injection 10 ml of 0.125 % of Bupivacaine + 50 mg tramadol.
2.Received injection 10 ml of 0.125 % of Ropivacaine + 50 mg tramadol.
Results: Epidural analgesia have been demonstrated to improve post-operative outcome, improve pain relief, patient satisfaction, and reduced morbidity in patient operated for abdominal surgeries.
Conclusion: -Ropivacaine is a long acting compare to Bupivacaine , it is equally effective for Epidural anesthesia and less cardiotoxic. Use of opioid with local anesthesia for epidural analgesia has been associated with decreased pain scores and reduced anesthetic requirement in post-operative period.
-Stable intraoperative hemodynamic parameters and duration of sensory blockage was more with Ropivacaine than in Bupivacaine .
-VAS was significantly higher with Bupivacaine than in Ropivacaine.
-However incidence of side-effects where observed in patients like bradycardia and hypotension. Overall both groups have no significant changes in of vitals. Also hypertension was common with Bupivacaine .
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Dr. Shweta S Mehta
Professor, Department of anesthesiology, Narendra Modi medical College, L.G. hospital , ahemdabad
Dr. Aditiba Gohil
Resident, Department: anesthesiology , Narendra Modi medical College
Dr. Nikunj H. Patel
2nd year Resident, Department of Anaesthesiology, Narendra Modi Medical college
Dr. Rohit L. Chauhan
1st year Resident, Department of Anaesthesiology, Narendra Modi Medical college