Online ISSN: 2515-8260

Keywords : tramadol


Shivering control with clonidine, butorphanol, and tramadol during spinal anaesthesia: a comparative study

Dr. Sachin Kumbhare, Arpit khandelwal, Sruthi T, Sujay Uday Gowalkar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 973-978

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.

A comparative study of tramadol suppository and ultrasound guided Transversus Abdominis plane block with bupivacaine versus tramadol suppository alone in providing post-operative analgesia after caesarean section

Nisheed Joseph, Bhagyashree Shivde, Swapna Naik, Gayathri Subhash Banasode

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 299-307

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.

Comparative study of intravenous clonidine versus tramadol for controlling shivering in regional anaesthesia for caesarean section in terms of efficiency, side effects & complications

Nilam Namdeo Waghmare, Anandkumar Harishchandrarao Pande, Hemat Shivram Pawar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1250-1256

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.

A study to compare the effects of low dose intrathecal fentanyl and low dose intrathecal tramodol combined with 0.5% bupivacaine heavy in patients undergoing orthopaedic surgeries

Dr. P. Anand Vijaya Bhasker, Dr Priyanka Priyadarshini.C, Dr Pasham Abbaiah, Dr Ramakrishna Shatagopam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4804-4813

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.

Comparative evaluation of tramadol via two different routes for post-operative analgesia after inguinal herniorrhaphy

Dr. Prerna Attal, Dr. Taninder Singh, Dr. Ranika Manhas, Dr. Sunayna Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2294-2300

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.

FETO maternal outcome in programmed labour protocol

Dr. Ravi Karad, Dr. Vijaya Harsoor, Dr. Amrutha AV

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2514-2520

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.

Comparison of intravenous ketorolac and tramadol as Adjuvants in control of post-operative pain in patientsundergoing laparoscopic surgeries under general Anesthesia in a tertiary care hospital

Vinuth K Murthy, Vridhi Rajan, Abraham AA

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 2862-2870

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.

Comprehensive Method For Forensic Study Of Pregabalin And Tramadol Trace Amounts Using Gas-Liquid Chromatography With Mass Spectrometric Detector And Ir-Spectrophotometry

M.U. Abdullaeva; N.Sh. Khalilova; A.Yu. Tashpulatov; Z.U. Usmanalieva

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 3330-3344

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.

A comparative study of tramadol versus ketorolac in pain management following third molar surgery

Dr. DeepaliJagdish Birla; DrPrashant Shriram; Dr. Hemant gadge; Dr.Priyanka Satpute; Dr.Nilesh Patil; Dr.Vaibhav Jain

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 5269-5273

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.