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Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 267-273

Tramadol as an adjuvant to peribulbar anesthesia

Department of Anesthesiology, Ain Shams University, Cairo, Egypt

Correspondence Address:
MD Wail Abdelaal
Assistant Professor of Anesthesia Ain Shams University; Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_50_19

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Background A large number of additives have been used as an adjuvant to local anesthetic (LA) mixture in peribulbar block to fasten the onset, enhance the potency, and prolong the duration of the block to cover the long duration of vitreoretinal surgeries and provide better postoperative analgesia. The authors designed a prospective, randomized, double-blind, controlled clinical trial to assess the effect of adding tramadol 20 mg to standard LA mixture concerning the onset of lid and globe akinesia, time for satisfactory block, and duration of postoperative akinesia and analgesia. Patients and methods A double-blind randomized study was done on 80 American Society of Anesthesiologists I and II patients scheduled for elective vitreoretinal surgery. Patients were chosen randomly into two groups, with 40 patients in each group. Group I (control group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) with 1 ml normal saline to a total volume of 10 ml. Group II (tramadol group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) supplemented with 20 mg tramadol in 1 ml normal saline to a total volume of 10 ml. The onset and duration of lid and globe akinesia and optimum time to begin surgery were recorded, in addition to postoperative visual analog score, duration of analgesia, and time to first rescue analgesic request. Results The results show statistically significant differences between the two groups, as tramadol group had faster onset of akinesia, better akinesia score, and shorter time needed to start surgery. In addition, tramadol group also showed significantly prolonged postoperative analgesia and akinesia with lower median pain score and less postoperative analgesic requirements. Conclusion The present study concluded that tramadol is a safe adjuvant to LA in peribulbar block that fastens the onset and prolongs the duration of lid and globe akinesia and improves the quality of analgesia without any obvious adverse effects.

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