European Journal of Molecular & Clinical Medicine

Background: Narcotics when used for postoperative analgesia may release histamine and cause bronchospasm in asthmatic patients. The present study was conducted to compare ketamine and tramadol for postoperative analgesia in asthmatics.
Materials & Methods: 60 asthmatic patients of both genders were divided into 2 groups of 30 each. Group I received ketamine-midazolam infusion preceded by a bolus of ketamine 0.5 mg-kg-' IV. Group II received a bolus dose of tramadol (2 mg/kg) followed by an intravenous infusion (0.2 mg · kg⁻¹· h⁻¹) postoperatively. Parameters such as Forced vital capacity in 1 s (FEV₁), respiratory rate, pain score in minutes and sedation score was compared.
Results: Group I had 16 males and 14 females and group II had 12 males and 18 females. There was significant difference in respiratory rate and non- significant difference in forced vital capacity in 1 s (%) and pain score in minute in both groups. The mean sedation score at baseline was 3.2 in group I and 5.2 in group II, at 1 hour was 2.5 in group I and 4.7 in group II, at 2 hours was 2.3 in group I and 3.4 in group III and 1.7 in group I and 2.8 in group II. The difference was significant (P< 0.05).
Conclusion: Both Ketamine and tramadol infusion can provide a safe alternative to the usual parenteral narcotic therapy in asthmatics in terms of analgesia

The aim of present study is to observe the effect of different doses of intrathecal tramadol as an adjuvant in subarachnoid block to prolong the duration of analgesia. All patients were evaluated thoroughly in preanesthetic checkup a day before surgery. During the preanesthetic evaluation a thorough general and systemic examination was done. The patients were examined clinically to note demographic data, baseline heart rate, blood pressure, respiratory rate, oxygen saturation of Hb. History of underlying medical illness, previous surgery, anaesthetic exposures and hospitalization was enquired.
Result: The mean onset time for sensory block in group A patients was observed as 4.62 ± 0.49 minutes and for group B patients it was 4.47 ± 0.51 minutes. We observed onset time for motor block in group A and B that was 5.85 ± 0.61 and 5.56 ± 0.61 minutes respectively. Duration of sensory and motor block in group A patients receiving Tramadol 25 mg was 173.32 ± 12.37 and 158.50 ± 10.71 minutes respectively whereas the duration of sensory and motor block for the patients in group B receiving Tramadol 40 mg was 182.03 ± 10.89 and 167.29 ± 11.09 minutes. The time for demand of dose of rescue analgesic by the patients in both groups was 244.68 ± 8.59 minutes and 306.53 ± 28.56 minutes, significantly higher in patients who received 40 mg tramadol.
Conclusion: The study was carried out in young healthy subjects of either sex belonging to ASA grade 1 and 2. A thorough pre-anaesthetic check-up was carried out. The procedure was explained and informed consent was taken.
Data on onset and offset of sensory and motor block, degree of muscle relaxation, postoperative pain free period were recorded. Vital parameters and incidence of drug related complications were also noted. Observations were tabulated and statistical tests were applied to find out the significance of observations. The observations recorded have been discussed to derive the conclusions.

To compare the efficacy of epidural FENTANYL and TRAMADOL for post-operative analgesia in lower limb surgeries in terms of onset of analgesia, duration of analgesia, quality of analgesia and undesirable effect.
Material Method: This prospective randomized study was conducted to compare the analgesic efficacy and side effects of epidural fentanyl and that of epidural tramadol and included sixty (60) patients of either sex in the age range of 18-65 years, undergoing lower limb surgeries under Combined Spinal Epidural anaesthesia (CSE) with ASA physical status I & II. These were divided into two groups of 30 patients each. Group F- Fentanyl group and Group T- Tramadol group. Patients of Group F received 50 mcg of Fentanyl + 8ml of 0.125% Bupivacaine (9 ml) and that of Group T received 50 mg of Tramadol and 8ml of 0.125% Bupivacaine(9 ml).The patients were randomly given epidural fentanyl or epidural tramadol when patient complained of pain post operatively with Visual analog score 3 or above. Patients were closely monitored in the post-operative period till they had pain relief. Quality of pain relief was measured using visual analogue scale and occurrence of side effects like nausea and vomiting, pruritis, respiratory depression were noted.A detailed clinical history and physical examination of the patients was done and all vital parameters were recorded well in advance. An informed and written consent was taken from the patient for the study.
Result: Mean Time of onset of analgesia after epidural injection was 5.42 ± 1.18 minutes in Group F and 12.80 ± 1.62 minutes in Group T and the difference was found to be statistically significant. Mean Duration of analgesia was 240.22 ± 36.53 in Fentanyl group and 360.52 ± 24.83 in Tramadol groups respectively which was also statistically significant. Pruritis was significantly higher in Fentanyl group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia was better following administration of epidural Fentanyl.
Conclusion: Both epidural Fentanyl and Tramadol are effective in relieving post-operative pain; however Fentanyl produced better patient satisfaction compared to tramadol but the duration of action was short.

Introduction: Ropivacaine, a newer long acting amide local anaesthetic and it has lesser side effects compared to Bupivacaine and is increasingly replacing Bupivacaine because of its similar analgesic profile and lesser cardiotoxicity. Tramadol hydrochloride is a weak centrally acting analgesic commonly used as adjuvant with local anaesthetic agents in epidural analgesia. Aims and objectives: The aim of this study was to compare the hemodynamic changes of 0.125% Bupivacaine with that of 0.125% Ropivacaine along with tramadol in patients undergoing intra abdominal surgery for post-operative analgesia. Material and Methods: Total 60 patients were taken scheduled for intra operative surgery ranging from 18-55 years in ASA grade I and II. They were randomly allocated to two groups of 30 each. Group R (n = 30) received an Epidural loading dose of 10ml 0.125% of Ropivacaine with 50mg tramadol. Group B (n =30) received an Epidural loading dose of 10ml 0.125% Bupivacaine with 50mg tramadol. Patients were assessed post-operatively every 15 min for heart rate, blood pressure, SPO2 for first hour and then after every 30 min till patient complained of pain. Result: Hemodynamically, patients in both the groups, were equally stable. Group-R (412 ± 46.56 min) was having much longer duration of post-operative analgesia as compared to Group-B (348 ± 48.31 min, p < 0.001). Conclusion: Ropivacaine and Bupivacaine shows a similar hemodynamic profile. Thus, Ropivacaine can be used as an alternative to Bupivacaine for postoperative pain relief through the epidural route in patients undergoing intra abdominal surgeries ,as a safe and effective agent

Background: Shivering is a physiological response to core hypothermia to increase metabolic heat generation. Prolonged impairment of thermoregulatory autonomic function under anaesthesia, along with cool operating room temperatures and cold infusion fluids, causes shivering.
Methods: This prospective study included 90 individuals who shivered under spinal anaesthesia during abdominal or orthopaedic surgery. On shivering, patients received a 1 mL intravenous bolus dose of 50 mg tramadol, 1 mg butorphanol, or 150 mcg clonidine. All 3 groups were compared for shivering control, time to cessation, recurrence, hemodynamic changes, axillary temperatures, and side effects. Data was processed using statistical methods.
Results: Butorphanol and tramadol decrease shivering better than clonidine. Butorphanol, tramadol, and clonidine totally decreased rigours in 83%, 73%, and 53% of patients, respectively. Clonidine (3.3±0.9 minutes) took longer than butorphanol and tramadol (2.1±1.0 minutes and 1.8 ±0.5 minutes; P 0.001).
Conclusion: Butorphanol controlled shivering with fewer recurrences than tramadol, but both were better than clonidine with an early onset of action. Both opioids reduce rigours better than α-2 agonists.

Background: The most common form of arthritis with approximately 250 million people worldwide conservatively estimated to be suffering from osteoarthritis of the knee alone. The present study was conducted to compare Oxaceprol and tramadol for knee osteoarthritis.
Material and methods: This prospective, comparative study was carried among patients diagnosed as Osteoarthritis. A total of 200 patients randomized in two study groups of 100 patients each. Each group was given either oxaceprol 200 mg capsule or tramadol 50 mg capsule, thrice daily after food, for 12 weeks. The primary efficacy variable for this study was symptom relief and was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The data have subjected to Paired and Independent t-test as applicable. P values less than 0.05 were considered as significant.
Results: In the present study a total of 200 patients randomized in two study groups of 100 patients each were included in the study. Each group was given either oxaceprol 200 mg capsule or tramadol 50 mg capsule. In tramadol group 45% were males and 55% were females and mean age of participants was 51.37yrs whereas in Oxaceprol group 48% were males and 52% were females and mean age of participants was 50.42 yrs. No statistically significant difference was observed between groups for WOMAC scores. Significant reduction in pain, stiffness and physical function was observed between oxaceprol and tramadol group at baseline and after 6 months follow-up.
Conclusion: The present study concluded that Oxaceprol efficacy and tolerability was comparable with tramadol and the drug can be considered as an alternative to low-potency opioids in the management of knee osteoarthritis.

Aims: To compare the duration of analgesia and side effects of tramadol via two different routes i.e intravenous and rectal administration.
Settings and Design: The study design was Prospective, randomized, single blind and hospital based.
Methods and Material: Sixty adult patients of ASA grade I and II posted for inguinal hernia surgery were randomized to receive either rectal suppository of tramadol 100mg (n=30) Group R or I.V. tramadol 50 mg (n=30) Group I. Pain measurement was performed using visual analogue scale (VAS). Rescue analgesia was given when the VAS was >3 in the postoperative period up to 24 hrs. Side effects like nausea, vomiting, were recorded during the same period.
Statistical analysis used: All data was analysed using the Chi square test and Z-test.
Results: Duration of analgesia was prolonged and requirement of rescue analgesic was less with the suppository group. Nausea and vomiting were also lower with the suppository group.
Conclusions: Rectal suppository of tramadol as well as intravenous tramadol are effective for postoperative analgesia after inguinal herniorraphy, but rectal tramadol is better alternative than I.V. tramadol as it has longer duration of pain relief and lesser incidence of nausea and vomiting.

The aim of this study is to evaluate the efficacy of Tramadol administered epidurally along with 0.375 % Bupivacaine in patients undergoing lower limb surgeries. Patients with absolute contra- indication for epidural block like bleeding disorders or patients on anticoagulant therapy or MAO inhibitors, with raised intra–cranial tension, infection at the site of injection, with neurological deficit and with psychiatric diseases were not included in this study. Patients who were chronic abusers of benzodiazepines and painkillers were also excluded from this study.
Result: The time required for sensory blockade to reach maximum level and then regression to L₁ level. There was no statistically significant diffrerence  between the two groups. Mean value for the onset of sensory blockade was found to be 11.55 ± 1.71 in group I and 11.35 ± 2.28 in group II. Max level of blockade achieved was usually between  T ₇ to T ₁₀ . The time required for motor blockade. There was no statistically significant diffrerence  between the two groups. None of them had any patient scoring bromage scale 2 . time of regression of motor blockade from bromage scale 1 to 0 were 141.10 ± 4.59 & 144.65 ± 2.22 in groups I & II respectively.
Conclusion: No sedative or analgesic was given as preoperative or intraoperatively. Group I. patients received  20ml of 0.375%  bupivacaine 0.5% plain + 100mg tramadol (2ml) at different intervals. Addition of tramadol to Bupivacaine epidurally proved to be efficacious for treatment of postoperative pain than analgesic effect of Bupivacaine alone.

Background: The aim of the study was to compare multi-modal approach with Tramadol suppository
and Ultrasound guided Transversus Abdominis Plane (TAP) Block with Bupivacaine versus Tramadol
suppository alone in providing adequate post-operative analgesia after Caesarean section.
Method: 158 patients, aged between 18 to 40 years with ASA physical status I-II scheduled for elective
caesarean surgery, were enrolled in this prospective randomized comparative study. 79 patients (of Group
A) were given Ultrasound guided Transversus Abdominis Plane Block with Bupivacaine and Tramadol
suppository as post-operative analgesia. The remaining patients were given only tramadol suppository as
post-operative analgesic (Group B). They were observed for 12 hours or till the patient requested for
rescue analgesic. Pain (VAS score), satisfaction (Likert scale), sedation (Four-point sedation scale),
nausea & vomiting (PONV Impact scale) and adverse effects at 3hours, 6hours, 9hours and 12hours postoperatively
were observed and compared in both the study groups.
Results: Both groups were comparable in demographic data. There was a statistically significant
difference between the VAS scores and satisfaction scores with a p < 0.001 between the two groups. No
statistically significant differences in the sedation, PONV or adverse effects were found between the two
groups. In our study, Group A patients who received ultrasound guided TAP block remained painless for
longer period (23hours) than Group B (6.5hours).
Conclusion: In conclusion, our study suggests that Ultrasound guided TAP block significantly improved
postoperative analgesia in women undergoing Caesarean delivery patients.

Background: Labour pain is among the maximum excruciating pain experienced by all women. Labour pain impacts maternal psychology and course of labour causing apprehension, tension, and strain. Pain relief throughout labour is predicted to lessen maternal strain and improve maternal and perinatal outcome. Many Nonpharmacological & Pharmacological methods of pain relief available. In this study we are comparing efficacy & safety of Paracetamol & Tramadol as labour analgesics.
Objective: To analyse the outcome of Programmed labour protocol vs expectant management of labour with respect to
1. Mean rate of cervical dilatation.
2. Mean duration of first, second, third stage of labour.
3. Pain relief in labour.
4. Mode of Delivery.
5. APGAR scores at 1min and 5min.
Methods: All women admitted in the labour room, meeting the inclusion criteria and willing to participate in study are categorized into group A and group B.
Programmed labor group(A) and expectant group. (B)
The study group A includes primigravida at term in active phase. Admitted in labor who will receive Programmed labor protocol. And group B will be managed expectantly.
After obtaining informed consent all women willing to participate will be examined according to protocol.
Results: In our study both the groups were comparable in relation to age, gestational weeks and cervical dilatation. Most common mode of delivery was vaginal in both the groups. Duration of first stage of labour and second stage of labour is significantly reduced compared to control group. Pain relief scoring in study group moderate to complete pain relief is 85.7%.
Mean cervical dilatation among the study group was 2 cm/hour which is higher compared to the control group (1 cm/hour). In study group-11.5% underwent LSCS which is lesser compared to the control group (15.5%). All the babies had Apgar score of 7-9 at one and five minutes. 4babies in the control group had Apgar score of six at one minute and on resuscitation, they had Apgar score of 8-9 at 5 minutes. Mean Apgar of the babies at one and five minutes in both the groups were comparable.
Conclusion: Programmed labor is an easier, safer means for ensuring less painful delivery. It reduces the duration of the labour without serious maternal and neonatal side effects. Pain relief is effective with minimal maternal side effects due to the drugs used. Labour and childbirth are cherished by the mother and her family. It can be adapted safely in all Maternity hospitals in low risk gravid woman.

Background: Spinal anaesthesia is popular and safe anaesthesia technique for various surgeries. Shivering that develops following spinal anaesthesia is common problem due to impairment of thermoregulatory control. Present study was aimed to compare the efficacy and safety of intravenous Tramadol with intravenous Clonidine in controlling shivering in obstetric patients under regional anaesthesia for caesarean section.
Material and Methods: Present study was single-center, prospective, comparative study, conducted in pregnant women, 18-40 years age, ASA grade I & II, developing shivering intra operative or postoperative in emergency or elective section. Drug therapy started as per patient group after delivery of baby
as Group C received Clonidine 0.5mcg per kg i.v while group T- received tramadol 0.5mg per kg i.v. Results: There was no significant difference in pre operative temperature, HR, SBP, DBP and SpO2 in both groups and even after the control of shivering. Mean time required to control the shivering in Tramadol group is 2.77 minutes is significantly less as compared to the Clonidine group which is 5.47 minutes (p< 0.001). Response rate that is the percentage of patients in which shivering controlled in 15 minutes after the treatment is 95% in Tramadol group and 82.5% in Clonidine group. The difference was not significant statistically (P-value 0.155). No side effects were noted in tramadol group, while 3 patients had side effects in clonidine group (3 cases had sedation), difference was not significant statistically.
Conclusion: Tramadol as compared to Clonidine is safe and effective in controlling the shivering in obstetric patients receiving spinal anaesthesia. Side effects were nil with tramadol, while patients received Clonidine were more sedated. Tramadol should be used for management of intra-operative shivering in regional anaesthesia for caesarean section.

Background: Various adjuvants have been used with local anesthetics in spinal
anesthesia to avoid intraoperative visceral and somatic pain and to provide prolonged
postoperative analgesia.
Aims: To compare the intraoperative effects of a single low dose of intrathecal tramadol
and intrathecal fentanyl with hyperbaric bupivacaine hydrochloride.
Materials and methods: Fifty patients undergoing Orthopaedic Surgery were randomly
allocated to two groups to be given the following agents by intrathecal route: Group A:
0.5% Bupivacaine 3.0 ml and 25 micro grams fentanyl and Group B: received 0.5%
Bupivacaine 3.0 ml and 25 milligrams tramadol. Intraoperative hemodynamics, pain
scores (assessed using a visual analogue scale), post-operative pain relief and side effects
in both groups was evaluated clinically.
Results: Intraoperatively no significant differences in BP, pulse rate and respiratory
rate were noted. Time to full motor recovery was not delayed in any of the patients in
both the groups. The mean duration of analgesia did not differ in both groups. Mean
duration of analgesia in Group A was 562 minutes and in Group B was 551.2 min. Time
for two segment regression did not differ in both the groups. The patients in both the
groups showed minimal side effects, like nausea, vomiting and pruritis. The incidence of
side effects were statistically in significant.
Conclusions: Both intrathecal tramadol and intrathecal fentanyl act synergistically to
potentiate bupivacaine induced sensory spinal block. Excellent surgical anesthesia and
an extended analgesia was observed in post-operative period with minimum side effects
were observed in both groups.

Aim and Objectives:To assess and compare the analgesic effects of adjuvants like
intravenous Ketorolac and Tramadol in laparoscopic surgeries on post-operative pain and
their side effects.
Methodology: In this quasi experimental study,after approval from ethical committee and
written informed consent taken from 90 patients of ASA physical status I,II of either sex
scheduled to undergo elective laparoscopic surgeries under general anaesthesia were
enrolled.Patients were randomly divided into one of the two groups of 45 patients each,
patient received either Ketorolac (Group K) or Tramadol (Group T) 30 minutes before
extubation. The degree of post-operative pain was assessed using VAS at 0, 2, 4 hours post
operatively upto 24 hours and the need of rescue analgesic and the side effects of both drugs.
Results: The pain score at 0 hours were more than 4 in both the groups.
Statisticalanalysisshowedasignificantdifferencebetweenthe2groups in the second and fourth
hour.Thereafter, the difference in pain scores in both Ketorolac group and Tramadol group
were not significant.
Conclusion: We conclude that both Ketorolac and Tramadol offer equal post-operative
analgesia while Ketorolac had lesser side effects when compared to Tramadol.

Research objective: to study the possibility of using the method of chromato-mass-spectrometry combined with IR-spectrophotometry in the forensic chemical analysis of trace amounts of unknown poisonous and superpotent substances.
Material and methods. For the forensic study a material evidence – an empty glass and a used empty disposable syringe were provided by the judicial and investigation authorities, taken from the crime scene. The following tasks were set before the experts: to find traces of any substances in the glass and syringe and reveal the origin of the poisonous and superpotent substances; determine the name of the substances.
Results. During the conducted analysis using gas-liquid chromatography with the mass spectrometric detector and IR spectrophotometry, the complex method was developed for the forensic chemical examination of pregabalin and tramadol trace amounts on the object-carriers. The research established the analysis parameters such as retention time, molecular and fragmentation ions, their intensity, individual fragmentation of pregabalin and tramadol. IR spectra were obtained with characteristic passbands of functional groups related to pregabalin and tramadol structures.
Conclusion. The research proved that application of the complex methods, which have high sensitivity, speed and simplicity in use, affords to quickly and accurately identify unknown substances in the composition of micro-objects.

Background: The present study was conducted to compare tramadol versus ketorolac in pain management following third molar surgery.
Materials & Methods: 56 cases of impacted mandibular third molar were divided into 2 groups of 28 each. Group I patients were given tramadol 50 mg intravenously before the surgery and group II patients were given ketorolac 30 mg intravenously before the surgery.
Results: The amount of local anesthetic used was 5.8 in group I and 5.2 in group II, mean operating time was 18.2 minutes in group I and 17.1 minutes in group II, mean VAS was 21.0 mm in group I and 15.4 mm in group II, total analgesic consumption was 6.5 tablets in group I and 4.2 tablets in group II and mean global assessment scores was 2.7 in group I and 3.4 in group II. The difference was significant (P< 0.05).
Conclusion: Tramadol is a suitable and safe analgesic for the relief of post-extraction pain following mandibular third molar extraction surgery as compared to Ketorolac.