The effect of tramadol adjunct to ropivacaine in continuous femoral nerve block in patients undergoing total knee arthroplasty for postoperative pain treatment Total di̇z artroplasti̇si̇ yapilan hastalarda postoperati̇f aǧri tedavi̇si̇ amaci i̇le femoral si̇ni̇r bloǧunda sürekli̇ i̇nfüzyon yöntemi̇ i̇le ropi̇vakai̇ne adjuvan tramadol etki̇si̇

Ekmekçi P., Yilmaz A. A., Özgencil E., Hasdoǧan M., Akan Ö., Ökten F.

Anestezi Dergisi, vol.18, no.4, pp.194-200, 2010 (Scopus) identifier

  • Publication Type: Article / Article
  • Volume: 18 Issue: 4
  • Publication Date: 2010
  • Journal Name: Anestezi Dergisi
  • Journal Indexes: Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.194-200
  • Keywords: Analgesia, Arthroplasty, Hip replacement, Nerve block, Ropivacaine, Tramadol
  • Ankara University Affiliated: Yes

Abstract

Objective: The use of peripheral nerve blockade following total knee arthroplasty is a simple and effective method with lesser cost and complications. Besides, this method causes good patient satisfaction, early mobilization and a short period of hospitalization. In the present study we evaluated the effectiveness of tramadol added to ropivacaine during preemptive femoral blockade in patients under going total knee arthroplasty. Method: Sixty patients undergoing total knee arthroplasty were included to the study. In all groups general anesthesia was performed and before the surgery femoral blockade with ropivacaine 0.5 % (0.3 mL kg-1) was done. In group I, ropivacaine 0.2 % was infused at a rate of 0.1 mL kg-1 hr -1 for 48 hours. In group II tramadol 1 mg mL-1 and in group III 2 mg mL-1 was added to ropivacaine infusion. At the end of surgery VAS, motor blockade and side effects were evaluated and PCA was done as continous infusion. As additional analgesic, intramuscular diclofenac 75 mg was done in patients with VAS values >40. VAS values, additional analgesic consumptions, blood pressures, heart rates and side effects were recorded at the postoperative 0, 2, 4, 6, 12, 24 and 48th hours. Results: VAS scores for 48 hours were <40 in three groups and was lower in Group III than in Group I and II although it was not statistically significant. Addition of tramadol did not lower additional analgesic requirement but increased analgesia time and quality. The incidence of side effects was higher in Group III (p<0.05). Conclusion: The effect of adding tramadol as an adjuvant to local anesthetics in "3-in-1" femoral block in postoperative analgesia was investigated and it was found that although not statistically significant, it increased the duration and quality of analgesia. However, postoperative additional analgesic requirement was higher in group II and incidence of side effects was higher in group III and this lowers the beneficial effect of adding tramadol to local anesthetics in lower extremity blocks and limits its usage.