Epidural dexamethasone and epidural tramadol for postoperative analgesia in patients undergoing abdominal surgeries: A comparative study

Abstract

Background: After surgery, systemic opioids are typically administered to relieve pain. The quest for an improved opioid never stops. In this trial, tramadol, an opioid, is utilized in opposition to dexamethasone. Dexamethasone has a potent anti-inflammatory activity and has proven to reduce morbidity after surgery. This study aims to investigate the effects of epidural bupivacaine combined with dexamethasone versus tramadol on postoperative analgesia in individuals undergoing lower abdomen procedures.
Material and methods: Two groups of sixty patients, ages 18 to 60, were assigned to elective lower abdominal operations performed under general anesthesia (group T and group D). In Group D (n=30), patients were given 8ml of 0.25% Bupivacaine with 2ml (8 mg) of Dexamethasone. In group T (n=30), patients were given 8ml of 0.25% Bupivacaine with 2ml (100 mg) of Tramadol. 10ml of medication was administered epidurally to each group at the onset of incisional wound closure. Patients were then extubated following reversal and moved to the postoperative care unit (POCU). An additional investigator, unaware of the group assignment, continued to observe and care for the patients. Hemodynamics were assessed every 15 minutes for the first hour followed by half hourly for 2 hours. Patients were evaluated and information was documented regarding the time first to rescue analgesia, which is defined as the interval between the end of block performance and the patient's initial request for rescue analgesia. Analgesia following surgery was recorded using a VAS (Visual Analogue Scale) score. VAS score and mean satisfaction score were recorded at 0, 1st, 3rd, 6th, and 12th postoperative hours.
Results: There were just slight variations in both groups' hemodynamics. The mean VAS was significantly lower in group D and the mean satisfaction score was better in group D. Requirement of analgesia and PONV was minimal in group D.
Conclusion: Therefore, for post-operative analgesia following abdominal procedures, epidural dexamethasone can be utilized as an adjuvant in comparison to epidural tramadol to 0.25% bupivacaine.