Intra-Operative Analgesia during Cesarean section: A Double Blind Clinical Trial Comparing the Effect of Tramadol versus Fentanyl on Both the Mother and the Neonate


Background: Tramadol had been recommended as an analgesic agent during vaginal delivery. Analgesia during cesarean section stills a matter of controversy with the effect on the fetus and maternal awareness and recall.Purpose: At this study, tramadol had been tested versus fentanyl as an adjuvant to general anesthesia for patients undergoing caesarian section. The effect on both, the mother (recall or awareness during surgery and post operative nausea and vomiting, and the neonate as the effect on Apgar score and the umbilical cord venous blood gases.Method: Forty pregnant ladies assigned to have elective cesarean section, had been divided blindly in tramadol group (n=20) and fentanyl group (n=20). Tramadol group had received 100 mg IV. And the fentanyl group had received 100 µg IV. Anesthesia induced by thiopentone sodium in a dose of 3 mg/kg B. wt, suxamethonium chloride 1.5 mg/ kg. B. wt, anesthesia was maintained by 100% oxygen and analgesia by tramadol or fentanyl with incremental on and off 0.5% halothane.Results: The Apgar score on both groups at 1 and 5 minutes shows no difference, the umbilical vein PO2 of the fentanyl group is higher than tramadol group; the PCO2 of the umbilical vein in tramadol group is higher than fentanyl group. Post operatively, 2 patients in tramadol group shows recall of the child crying during surgery, and four patients from tramadol group suffer from nausea and/ or vomiting.Conclusion: Tramadol is associated with high incidence of maternal recall and awareness, with significant reduction in umbilical vein PO2 in spite of no effect on Apgar scoreKey words: Intra-operative analgesia, umbilical vein gases, Apgar score, postoperative nausea and vomiting (PONV)