Analgesic effectiveness of intrathecal tramadol added to Bupivacaine compared with Bupivacaine alone for spinal anesthesia For Mothers Delivered by Cesarean Section at Empress Zewditu Memorial Hospital, Addis Ababa, Ethiopia.

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Addis Ababa Universty


Background: Spinal Anesthesia has become more widely practiced anesthetic technique. It is simple to institute, rapid in its effect and produces excellent operating conditions. Postoperative pain after cesarean section is common and more intense compared to post vaginal delivery pain. Therefore, intrathecal adjuvants play an important role in maternal analgesia in the postoperative time. It has been shown in clinical studies that using tramadol intrathecal can provide longer duration of analgesia, without the common side effects of opioids. Objective: To compare analgesic effectiveness of intrathecal tramadol as an adjuvant with bupivacaine in comparison with bupivacaine alone for mother delivered by cesarean section at Empress Zewditu Memorial Hospital from January 1 to March 30, 2018. Methods: Hospital based observational prospective cohort study was employed for 62 laboring mothers who fulfilled inclusion and deliver by cesarean section under spinal anesthesia selected with systematic random sampling from schedule list. Data was collected immediately after SA administration at 5, 10, 15, 20, 30, 40 minutes. Starting from the immediate postoperative time, an assessment was done at 1, 2, 3, 4, 5, 6 and 12 hours for numerical rating scale (NRS). Based on normality assumption, analysis was done by independent t test, Mann –Whitney U test, χ2 or Fisher’s exact test as appropriate. P-value <0.05 was consider as statistically significant. Result: Hemodynamic change was comparable and there was no adverse effect between the groups. The median pain scores were lower in exposed (BT) group at the 2nd, 3rd, 4th and 5th hours postoperatively and there was statistical significant difference at 2nd, 3rd, 4th and 5th hours postoperatively between exposed (BT) and non-exposed (BA) groups (p<0.001). The duration of anesthesia was effectively prolonged in group BT (245.33 ± 22.854 minutes) compared to group BA (135.00 ± 21.735 minute) (p<0.001). Conclusion and Recommendation: This study showed that intrathecal tramadol (20 mg) can safely be used along with bupivacaine in subarachnoid blockade to prolong the duration of analgesia. We recommend the use of intrathecal tramadol additive for effective post-operative analgesia for cesarean section.



Spinal Anesthesia,Empress Zewditu Memorial Hospital