A DOUBLE-BLIND RANDOMIZED STUDY TO COMPARE THE ANALGESIC EFFECTS OF TRAMADOL AND BUPRENORPHINE IN PATIENTS UNDERGOING LOWER ABDOMINAL AND LOWER LIMB SURGERIES UNDER SPINAL ANESTHESIA WITH 0.5% BUPIVACAINE

Abstract

Background: Intrathecal opioids are routinely used as adjuncts to local anesthetics (LA) in spinal anesthesia (SA). Buprenorphine is a mixed opioid agonist-antagonist with high affinity for mu and kappa opiate receptors while tramadol (TDL) is an opioid having low affinity for opioid receptors. The effects of intrathecal TDL with bupivacaine were compared to intrathecal buprenorphine with bupivacaine for post-operative analgesia in lower abdominal and lower limb surgeries.
Methods: A total of 132 patients undergoing specified surgeries (lower abdominal/limb) under SA were randomized to receive 3 ml of hyperbaric bupivacaine premixed with either 60 mcg buprenorphine (Group BB), tramadol 10 mg (Group BT), or 0.2 ml normal saline (Group BS). Postoperative details of visual analog scale (VAS) score for pain, time to first analgesic requirement, total analgesic requirement, and adverse effects for 24 hours post-operative period were recorded.
Results: Prolonged post-operative analgesia was observed in Group BB (549.09±103 min) compared to Group BT (446.48±77.40 min) and Group BS (312.73±30.45 min). The reduction in post-operative shivering was noted in TDL group. Post-operative rescue analgesic requirement was significantly lesser in group buprenorphine (P=0.042).
Conclusion: Intrathecal buprenorphine showed a longer duration of action with lesser postoperative rescue analgesic requirement as an adjunct to bupivacaine for subarachnoid block than intrathecal tramadol.