Non-opioid Analgesia, the Effect of Adding Tramadol or Neostigmine as an Adjuvant to 0.5% Bupivacaine in Spinal Anesthesia


Abstract:Background: The addition of the non-opioid agents to intrathecal bupivacaine will prolong or may double the time for the first rescue analgesic dose in the postoperative period without the unwanted side effects of opiates which they are usually added as adjuvants to intrathecal local anesthetic. This study was aimed to evaluate the effect of tramadol and neostigmine as an adjuvant to 0.5% intrathecal bupivacaine as effects and side effects. Method: Ninety patients enrolled in double-blinded controlled clinical trial, divided randomly into 3 groups. Group 1 had received 20 mg bupivacaine. Group 2 had received 20 mg bupivacaine and 20 mg tramadol. Group 3 had received 20 mg bupivacaine with 20 µg neostigmine. The blood pressure, pulse rate, SpO2 and ECG were monitored. The time of the first analgesic rescue dose of tramadol and diclofenac sodium had been recorded. The time of the first sign of motoric activity had been recorded. The incidence of headache and nausea and/or vomiting had been recorded. One-way ANOVA and Kruscall-Wallace test had been used and p < 0.05 was considered significant. Results: The time of analgesia with group 1 was only 173±35 minutes, while group tramadol and neostigmine had recorded 368±59 and 377±67 minutes respectively (p < 0.05). The time of motoric recovery was 153±47 minutes for bupivacaine, 165±48 minutes for tramadol group and 155±46 minutes for neostigmine group (p > 0.05). Nausea and/or vomiting incidence was 80% of neostigmine group, while 16.7% and 10% in tramadol group and bupivacaine group respectively. Conclusion: The addition of tramadol or neostigmine in low doses, prolong the analgesic effect of bupivacaine in spinal anesthesia without any motoric latency. Tramadol is superior to neostigmine as it carries fewer incidences of postoperative nausea and/or vomiting.Key words: non-opioid analgesia, bupivacaine, tramadol, neostigmine, postoperative nausea and vomiting