Comparative study of duration of analgesia with epidural bupivacaine and bupivacaine with tramadol in lower limb surgeries

Dipti Saxena, Sadhana Sanwatsarkar, Atul Dixit, Bipin Arya


Background: The administration of local anaesthetic and opioid mixture via epidural route is excellent for post-operative pain during lower limb surgeries. This combination provides better quality of analgesia, lower side effects and high level of patient satisfaction. Therefore, this study was taken up to evaluate the efficacy safety, tolerance and side effects for the combination of tramadol and bupivacaine in the management of post-operative pain.

Methods: This was a prospective study where a total of 40 patients; 20 each in group I and II were selected. Patients who were admitted for lower limb surgeries   in age range of 18-50yrs and belonged to ASA grade I &II.  Group A was given epidural bupivacaine 0.5% and group B was given epidural bupivacaine 0.5% with tramadol 50mg. The parameters studied were onset of action, quality of anesthesia, degree of motor blockade, duration of analgesia, hemodynamic alterations, intraoperative and postoperative complications. Pain was evaluated with verbal score. Results were evaluated statistically.

Results: The mean duration of analgesia was significantly longer in patients with tramadol. The quality of analgesia and pain scores were better in patients who were administered tramadol.  The number of drug doses required was significantly reduced by addition of tramadol.

Conclusions: Tramadol is a safe and effective adjuvant to epidural bupivacaine for prolongation of total duration of analgesia in lower limb surgeries.


Analgesia, Bupivacaine, Epidural, Lower limb surgery, Tramadol

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Iqbal J, Manhas A, Ahmed I, Abeeda S, Habib M, Ahmed H. Epidural Anasthesia in Lower Limb Surgeries: A Comparison between Bupivacaine Alone and Bupivacaine with Tramadol. Br J Med Health Res. 2015;2(10):14-23.

Singh A, Prasad H. Comparative study of duration of analgesia with epidural bupivacaine & bupivacaine with tramadol in lower limb and lower abdominal surgeries. Int J Drug Del. 2013;5(2):239-44.

Fukuda T, Dohi S, Naito H. Comparisons tetracaine spinal anaesthesia with clonidine or phenylephrine in normotensive and hypertensive humans. Anaesth analg. 1994;78(1):106-11.

Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL et al. Complementary and synergistic antinociceptive interaction between the enantiomers of tramadol. J Pharmacol Exp Ther. 1993;267:331‑40.

Vickers MD, O’Flaherty D, Szekely SM, Read M, Yoshizumi J. Tramadol: Pain relief by an opioid without depression of respiration. Anaesthesia. 1992;47:291‑6.

O’Flaherty D, Szekely S, Vickers MD. Tramadol versus pethidine analgesia in postoperative pain. Pain 1990;5:179.

Lehman KA, Jung C, Hoeckle W. Tramadol and pethidine in postoperative pain therapy: A randomised double‑blind trial with intravenous on‑demand analgesia. Schmerz Pain Douleur. 1985;6:88‑100.

De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology. 2002;96(2):467-84.

Fu YP, Chan KH, Lee TK, Chang JC, Daiy YP, Lee TY. Epidural tramadol for postoperative pain relief. Ma Zui Xue Za Zhi. 1991;29:648‑52.

Delilkan AE, Vijayan R. Epidural tramadol for postoperative pain relief. Anaesthesia 1993;48:328‑31.

Siddik‑Sayyid S, Aouad‑Maroun M, Sleiman D, Sfeir M, Baraka A. Epidural tramadol for postoperative pain after Cesarean section. Can J Anaesth. 1999;46:731‑5.

Senel A C, Akyol A, Dohman D. Caudal Bupivacaine, Tramadol combination for postoperative analgesia in paediatric herniorrhaphy. Acta Anaesthesia Scand. 2001;45:786-9.

Choudhary AH, Dharmani P, Prakash N comparison of caudal epidural, bupivacaine with bupivacaine plus tramadol & bupivacaine plus ketamine for post operative analgesia in Children. Anaesth. Intensive Care. 2008;36(2):174-9.

Hirota K, Okawa H, Appadu BL. Interaction of local anaesthetics with recombinant mu, kappa and delta opioids receptors expressed in Chinese hamster ovary cells Br. J. Anaesthe. 2000;85(5); 740-6.

Anis Airbogan and Colleagues: comparison of tramadol with or without bupivacaine after major urologic studies. Uro Int. 2003;71:168-75.

Lin WQ, Zing WA. comparison of post-operative analgesia with tramadol, morphine versus their combination undergoing abdominal cancer surgery. Ai Zheng. 2002;21(7)794-6.

Vogel W, Burchardi H, Sihler K, Valic L. The effect of tramadol, a new analgesic, on respiration and cardiovascular function. Arzneimittel for schung. 1978;28(1a):183-6.

Lebedeva RN, Bondarenko AV, Nikoda VV, Chaus NI, Tugarinov SA. Clinical aspects of the use of nubain, tramal and moradol in patients in the early postoperative period. Anesteziol Reanimatol. 1992;(2):3-7.

Hackl W, Fitzal S, Lackner F, Weindlmayr-Goettel M. Comparison of fentanyl and tramadol in pain therapy with an on-demand analgesia computer in the early postoperative phase. Anaesthesist. 1986;35(11):665-71.

Baraka A, Jabbour S, Ghabash M, Nader A, khoury G, Sibai A. Comparison of epidural tramadol & epidural morphine for post-operative analgesia. Can J Anesth. 1995;40:308-13.

Vickers MD, Parvinic D. comparison of tramadol with morphine for abdominal Surg. Eur J Anesth. 1995;12:268-7.