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Original Article
Abstract
Background: Bupivacaine, tramadol, and pethidine has local anesthetic effect. The aim of this study was to
compare effect of subcutaneous (SC) infiltration of tramadol, pethidine, and bupivacaine on postoperative
pain relief after cesarean delivery.
Materials and Methods: 120 patient, scheduled for elective cesarean section under spinal anesthesia, were
randomly allocated to 1 of the 4 groups according to the drugs used for postoperative analgesia: Group P
(Pethidine) 50 mg ,Group T (Tramadol) 40 mg, Group B (Bupivacaine 0.25%) 0.7 mg/kg, and Group C (control)
20CC normal saline injection in incision site of surgery. Pain intensity (VAS = visual analogous scale) at rest
and on coughing and opioid consumption were assessed on arrival in the recovery room, and then 15, 30,
60 minutes and 2, 6, 12, 24 hours after that.
Results: VAS scores were significantly lower in groups T and P compared with groups B and C except for 24
hours (VAS rest) and 6 hours (VAS on coughing) postoperatively (P < 0.05). The number of patients requiring
morphine were significantly different between the groups (105 doses vs. 87, 56, 46, doses for group C, B,
T and P, respectively, P < 0.05) in all the times, except for 2 and 6 hours postoperatively.
Conclusions: The administration of subcutaneous pethidine or tramadol after cesarean section improves
analgesia and has a significant morphine-sparing effect compared with bupivacaine and control groups.
Key Words: bupivacaine, pethidine, post-cesarean section pain, spinal anesthesia, tramadol
INTRODUCTION
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Website:
www.advbiores.net
DOI:
10.4103/2277-9175.100165
Copyright: 2012 Jabalameli. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.
How to cite this article: Jabalameli M, Safavi M, Honarmand A, Saryazdi H, Moradi D, Kashefi P. The comparison of intraincisional injection tramadol, pethidine
and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res 2012;1:53.
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RESULTS
DISCUSSION
Table 1: Demographics data of patients (Mean MAP, RR, PR) before intervention and spinal needling site in 4 groups
Age (year)
MAP (mmHg)
PR (beta/min)
RR (rate)
L4-L5
Spinal needling site L3-L4
(N %) L2-L3
B n = 30
27.1 4.9
80 0.6
89 8
11 1
0-0
18-(60)
12-(40)
P n = 30
26.5 3.9
78 0.6
89 10
12 2
0-0
18-(60)
12-(40)
T n = 30
26.3 4.7
79 0.4
90 4
11 0.9
2-(6.7)
15-(50)
13-(43.3)
C n = 30
26.6 4.5
80 0.6
92 6
11 1
2-(6.7)
15-(50)
13-(43.3)
P value
> 0.05
0.45
0.42
0.18
0.98
MAP = Mean arterial pressure; PR = Pulse rate; RR = Respiratory rate data (Age MAP, PR, RR) are as Mean SD
Table 2: Recovery time, level of spinal block, Mean MAP, RR, PR after in 4 groups
Recovery time {mean SD (minutes)}
Level of block (n,%)
T4
T5
T6
MAP (mmHg)
RR (rate/min)
B (Bupivacaine) n = 30
74 14
P (Pethidine) n = 30
82 19
T (Tramadol) n = 30
71 12
C (Control) n = 30
69 11
P value
0.06
18-(60)
10 (33.3)
2 (6.7)
78.1 0.3
11 0.5
15-(50)
11 (36.7)
4-(13.3)
77.7 .30
11 0.7
21-(70)
9-(30)
0-0
77.4 0.2
10.7 0.4
18-(60)
11-(7.36)
1-(3.3)
78.5 0.3
10.9 0.5
0.19
0.33
0.07
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Table 3: VAS at rest and on coughing and frequency of morphine consumption at recovery o, 15', 30', 60', 2, 6, 12, 24 hours
postoperative in the 4 groups
15'
B n = 30
2.2 0.5
2 0.2
P n = 30
1.8 0.5
1.8 0.4
30'
2.2 0.5
60'
2h
6h
12 h
24 h
On coughing (0)
2.6 0.7
15'
2.9 1
31
3.6 1
2.3 0.7
2.6 1
2.1 0.6
30'
2.8 1.3
60'
2h
6h
12 h
24 h
Morphine consumption (% of total patients in each group)
(0)
15
30
60
2h
6h
12 h
24 h
3.7 1.5
3.7 1.7
3.8 1.9
4.7 2.1
2.8 1.4
26.7
6.7
23.3
46.7
53.3
46.7
66.7
23.3
T n = 30
20
20
C n = 30
2.2 0.5
2.3 0.4
P value
0.01
< 0.001
1.9 0.4
20
2.7 0.8
< 0.001
2.1 0.6
2 0.5
2.7 0.9
0.001
2.5 0.6
2.7 0.9
3.1 0.9
2.1 0.4
1.9 0.5
1.8 0.4
2.4 0.5
2.5 0.6
2.5 0.6
2.4 0.6
20
20
2.7 0.9
2.7 1
3.8 1
2.3 0.5
2.5 1
2.8 1.1
0.02
0.11
< 0.001
0.05
< 0.001
< 0.001
2.1 0.5
20
3.5 1.5
< 0.001
2.2 0.7
2.4 0.6
3.6 1.4
< 0.001
2.9 1
3.2 1.4
3.3 1.4
2.2 0.8
3.5 0.8
3 1.1
3.2 1
31
3.8 1.7
3.9 1.7
5.2 1.5
3 1.2
0.02
0.04
< 0.001
0.05
0
0
3.3
10
33.3
33.3
60
6.7
0
0
0
6.7
46.7
50
40
43.3
20
26.7
53.3
40
46.7
53.3
76.7
33.3
0.001
< 0.001
< 0.001
< 0.001
0.23
0.21
0.01
0.01
B (%)
10-33
10-33
10-33
P (%)
11-22
9-30
9-30
T (%)
10-33
10-33
10-33
C (%)
12-40
12-40
12-40
10-33
20-66.7
0
0
6-20
21-70
2-6.7
1-3.3
5-16.7
24-80
1-3.3
0
21-70
9-30
0
0
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Table 5: Mean arterial blood pressure (mmHg), heart rate (beta/min) and respiratory rate (rate/min) at the recovery (0), 15, 30,
60, 2, 6, 12, 24 hours postoperative in the 4 groups
B
P
T
MAP
HR
PR (mean MAP (mean HR (mean RR (mean MAP (mean HR (mean RR (mean
(mean (mean SD)
SD)
SD)
SD)
SD)
SD)
SD)
SD)
SD)
0
0.4074 75 6 10 0.8
72 0.5
77 8
10 2
72 0.3
77 3
10 1
15 75 0.5
84 6
10 0.6
75 0.6
83 1
10 1
75 0.3
83 3
10 2
30 76 0.5
83 6
11 1.0
78 0.5
83 8
10 1
75 0.4
84 6
10 1
60
79 6
85 8
12 1
79 0.5
85 8
12 2
78 0.4
84 5
12 1
2h
80 0.6
89 8
11 1
78 0.6
9010
12 2
79 0.4
90 4
11 0.9
6h
80 0.5
89 8
12 1
80 0.6
90 13
12 2
80 0.3
89 5
12 1
12 h 80 0.8
92 9
11 2
80 0.9
9011
11 1
80 0.3
90 5
11 1
24 h 80 0.4
87 6
11 1
80 0.5
85 9
112
80 0.2
85 5
11 0.9
C
MAP
HR (mean
(mean
SD)
SD)
74 0.5
78 6
75 0.5
85 9
78 0.5
86 8
78 0.5
87 7
80 0.6
92 6
80 0.6
91 6
80 0.6
92 7
80 0.5
87 6
RR (mean
SD)
10 0.8
10 0.7
10 1
12 1
11 1
12 1
11 2
11 0.9
6.
7.
8.
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