Amir Poya Zanjani, Mehdi Rezaee, Shahram Samadi, Omid Nabavian, Seyed Ali Emami Meibodi, Ali Kord Valeshabad,
Volume 13, Issue 0 (2-2024)
Abstract
Background: Anesthesiologists and surgeons strive as a team to minimize postoperative patient reported pain scores by using modern multimodal pain management protocols. This study was designed to examine the effects of adding different doses of adjuvant tramadol to bupivacaine solution in interscalene block (ISB) in patients undergoing shoulder arthroscopic surgery.
Methods: In this prospective controlled randomized double-blinded trial, 60 consecutive eligible subjects candidate for arthroscopic shoulder surgery were assigned randomly into 3 groups. The patients were assigned to receive one of the specific doses of tramadol in bupivacaine mixture in their preoperative ultrasound-guided ISB. In the control group (T0), the ISB was performed with 30 ml solution of perineural 0.25% bupivacaine and epinephrine. The block was performed with the same solution mixed with 100 or 200 mg of adjuvant tramadol with a total volume of 30 ml in patient in T100 and T200 groups, respectively. The required postoperative duration of analgesia, 24 hours postoperative analgesic consumption, observational and patient-reported pain scores, and side effects were recorded in the recovery room and up to 24 hours.
Results: Mean postoperative analgesia duration was significantly longer in group T200 (681 ± 270 min) than in Group T100 (501 ± 298 min) and Group T0 (402 +/- 223 min) (P =0.006). A statistically significant difference was found in the first 24 hour postoperative cumulative opioid consumption among groups T200 (5.5 +/- 3.2 mg), T100 (9.0 +/- 4.5 mg) and T0 (9.30+/- 4.78 mg) (P=0.009). There was no intergroup difference in intraoperative analgesic consumption, postoperative sedation score, and complications due to ISB or tramadol adverse effects.
Conclusion: There is a dose-dependent prolongation of ISB with adjuvant tramadol for arthroscopic shoulder surgeries.
