Posters
•
Postop. Pain Management
93
293. Preemptive intraarticular tramadol for pain control after arthroscopic knee surgery
295. Tripple component epidural mixtures with PCEA for orthopaedic surgery
Tuncer B, Babacan CA, Arslan M Email:
[email protected] Gazi University Faculty of Medicine Department of Anesthesiology Gazi University Faculty of Medicine Department of Anesthesiology 06500 Besevler ANKARA, Turkey
Atsalou M, Vasilakos D, Soilemezidou C, Goutziomitrou E, Karponis A, Blougoura E Email:
[email protected] Anaesthesiology Department “Papageorgiou”General Hospital, Thessaloniki, Naoussis 6,40 Ekklissies,54636 Thessaloniki, Ring Road,N.Efkarpia, Thessaloniki, GREECE
The purpose of this study was to determine the effectiveness of intraarticular bupivacaine and tramadol injection and preemptive intraarticular tramadol in providing pain control after arthroscopic meniscectomy. Unpremedicated 60 patients between ASA class I or II undergoing arthroscopic meniscectomy were included in the study. Preoperative visual analogue scale (VAS) scores were obtained from all patients by asking the average intensity of pain at rest and on movement of the knee. Patients were assigned in a randomized manner into three groups: Group I received 20 ml of 0.25% bupivacaine at the end of the operation, Group II received 20 ml of 0.25% bupivacaine and 100 mg of tramadol at the end of the operation and Group III received 100 mg of tramadol diluted in 20 ml of saline solution 30 minutes before skin inscision and 20 ml of 0.25% bupivacaine at the end of the operation as well. All patients received standard total intravenous anesthesia. Postoperative pain scores were evaluated at 1, 2, 4, 6, 8, 12 and 24 hours at rest and on movement of the knee using VAS. In case of inadequate analgesia (VAS⬎3), patients in all groups received sodium diclophenac, i.m. 75 mg of starting dose as a rescue medication once it was requested and at a maximum dose of 150 mg daily. Sedation wase evaluated using Ramsay Sedation Scale at the same postoperative time points. Patients were asked to indicate the degree of overall satisfaction with postoperative pain management on a 4-point satisfaction scale before discharge. There were no significant differences among the groups with respect to demographic variables, total propofol consumption, side effects and sedation scores. Analgesic duration, total analgesic consumption and postoperative VAS pain scores recorded at rest and with movement were significantly lower and patient satisfaction was significantly higher in Group II and III when compared to Group I. Total analgesic consumption and the number of patients requiring supplementary analgesics were significantly lower in the preemptive tramadol group compared to postoperative tramadol group. In conclusion, intraarticular tramadol and bupivacaine either applied preoperatively or postoperatively provided better pain control than intraarticular bupivacaine alone without any significant side effects. Analgesic effect was more significant when tramadol was applied preemptively.
Background and purpose: Local anaesthetics have been used widely for postoperative epidural analgesia. Recently, balanced analgesia consisted of low concentration local anaesthetics with added low dose opioids and adjuvants, improved quality of analgesia and decreased following side effects as PCEA also titrated the given solutions. Aim of the study was the comparison of two treatment multimodal regimens for postoperative analgesia using PCEA, regarding their safety and efficacy. Materials and method: Sixty two ASA I-III patients, undergoing orthopaedic or traumatologic surgery under CSE anaesthesia, were enrolled for prospective study and randomly assigned to two treatment groups, respectively to the mixtures. BCM group (n⫽39pts)contained Bupivacaine 0,0625% plus Clonidine 150mcg and Morphine 4mg and LCM group (n⫽23 pts) also contained Levobupivacaine 0,0625% plus Clonidine 150mcg and Morphine 4mg. All patients after sensory and motor block release received the prepared solutions (360ml) by the electronique pumps (Abbott Gemstar) with continous infusion rate 6ml, bolus amount 2ml, lockout period 10min and an hour limit 10ml. Haemodynamics, adverse reactions, additional rescue intramuscular analgesics, patients’ satisfaction were recorded and analysed using repeated measures with analysis of variance and chi square test. Recordings of pumps’ settings and the analgesic histories relative to the mixtures were evaluated with student T test. Results: Groups had similar demographic data. Seven patients (LCM group) were excluded from the study due to occlusion of the pumps. Analgesic profile of both groups was comparable over the time of infusions’ consumption and they were both very satisfied. Overall 5 patients needed supplemental analgesia 9.4% in spite of 90.6% that they didn’t. Haemodynamic instability due to mixtures, either neurotoxicity or immobility were not noted. A patient suffered nausea (1.9%,p⫽0.60), 2 patients vomitting (3.8%, p⫽0.64) and 2 patients pruritus (4,2%, p⫽0.56). Conclusion: Both multimodal regimens were effective and safe for PCEA postoperative analgesia in orthopaedic surgery. Reference: A Direct Search Procedure to Optimize Combinations of Epidural Bupivacaine, Fentanyl and Clonidine for Postoperative Analgesia.Anaesthesiology Feb.2000;Vol.92:2
