INTRATHECAL TRAMADOL AS AN ADJUVANT IN SUBARACHNOID BLOCK TO PROLONG THE DURATION OF ANALGESIA

Addition of tramadol did not produce any adverse effects on hemodynamic profile or any other typical side effects of pure opioid agonists such as nausea, vomiting, pruritus and respiratory depression. In his study 20 mg of tramadol added to 15mg of bupivacaine effectively prolonged the duration of analgesia from 210 ± 10.12 min in bupivacaine saline group to 380 ± 11.82 min in bupivacaine-tramadol group10 A comparative study of 50 mg tramadol and 2 mg nalbuphine used in subarachnoid block done by Mostafa MG20 demonstrated equally effective prolongation of duration of analgesia and Lower VAS scores along with minimal side effects related to these agents although sedation score was found to be higher in tramadol group. Addition of 25 milligram of tramadol in subarachnoid block with 10 milligram of 0.5% bupivacaine effectively improve quality of blockade and most importantly prolonged the duration of blockade for surgery 0.25 mg dose of tramadol was added after reviewing many authors and considering it to be a adequately safe dose as this was a first study of adding intrathecal adjuvant for surgery and it did not produce any anticipated adverse effects but it did produce admirable result. Twenty five mg of tramadol is a safe dose with minimum side effects and it should be utilized as a starting point for more studies to improve the quality of anesthesia and patient care and most importantly the pain free experience for the patients.