Comparative study between tramadol and pethidine when added to lidocaine for intra venous regional anesthesia

الملخص EN

Introduction both pethidine and tramadol have a local anesthetic effect and thus can be used for-intravenous regional anesthesia (IVRA).

Aim of this work is to compare the local anesthetic and analgesic action of lidocaine alone, tramadol added to Udocaine and pethidine added to lidocaine in IVRA for surgeries on the upper limb.

Patients and methods: A prospective nonrandomized case series study included 60 patients ASA physical status I and II scheduled for forearm surgery using IVRA.

The patients were classified into three groups:- Lidocaine group (L):- Included 20patients, as a control group, and they received lidocaine hydrochloride 200 mg (0.5%) diluted in 40 ml normal saline, Pethidine group (P):- Included 20 patients who received Pethidine hydrochloride 100 mg (0.25%) added to lidocaine hydrochloride 200 mg (0.5%) diluted in 40 ml normal saline and Tramadol group (T):-Included 20 patients who received tramadol hydrochloride 100 mg (0.25%) added to lidocaine, hydrochloride 200 mg (0.5%) diluted in 40 ml normal saline.

The patients were assessed for onset and recovery of sensory and motor block, visual analogue scale (VAS) for tourniquet and forearm pain, presence or absence of postoperative pain and time to first analgesic requirement.

Results: The onset of pinprick and touch loss was significantly shorter in pethidine and tramadol groups in comparison to lidocaine group (p <0.001), while their recovery was longer (p<0.001 and p<0.05 respectively).

The onset of pinprick and touch loss in pethidine group was significantly shorter in comparison to tramadol group (p <0.05).

The pinprick recovery in pethidine group was significantly shorter than in tramadol group (p <0.05).

The onset of motor block in tramadol and pethidine groups was significantly shorter in comparison to lidocaine group (p <0.01, p <0.05 respectively).

There was no significant difference in the onset of motor block between tramadol and pethidine groups.

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The motor recovery in all three groups was comparable and the difference was statistically non-significant.

For tourniquet pain VAS was significantly less at 10 min.

and 20 min in the pethidine group in comparison to the lidocaine group(p<0,01 and p<0.05 respectively).

For forearm pain, VAS n>as significantly less in tramadol and pethidine at 10 minutes in comparison to lidocaine group (p <0.01, p <0.001 respectively).

At 20 min there was no pain in all groupsu Postoperative analgesic requirements The mean time to the first analgesic requirement in pethidine and tramadol groups was greater than in lidocaine group (P < 0.001).

The mean lime to the first analgesic requirements in tramadol group was greater than in pethidine group (P <0.05).

Recorded side effects the incidence of tachycardia was more significant in pethidine group (40%) in comparison to the other groups.

Conclusion: Our results suggest that, both tramadol and pethidine have a local anaesthetic effect on the peripheral nerves.

Both of them enhance the speed of onset of sensory and motor block, induce better anesthesia and analgesia for tourniquet and forearm pain, improve Postoperative analgesia and reduce postoperative analgesic requirements after tourniquet deflation f hen added to lidocaine.

But tramadol is considered to be safer than pethidine.