Comparative Study between Intrathecal (Bupivacaine Tramadol Mixture) versus Intrathecal (Bupivacaine Fentanyl Mixture) for Postoperative Analgesia in Patients Undergoing Infra-Umbilical Surgeries: Prospective Controlled Study

Background: Several adjuvants have been given via the central neuraxial pathway to lengthen the duration of analgesia brought on by local anesthetic (LA). After a range of surgical procedures, it has been shown that intrathecal opioid injection effectively provides postoperative analgesia.
Objectives: The primary outcome was to compare the duration and the quality of postoperative analgesia, secondary outcomes included intraoperative haemodynamic effects and operative side effects.
Methods: 120 patients (ASA1̵ 11) undergoing infraumblical surgeries under spinal anesthesia were randomly allocated into 3 groups (n =40): Group (BF) that received hyperbaric 0.5% bupivacaine (0.25: 0.30 mg/kg) + 30µg fentanyl. Group (BT), which received hyperbaric 0.5% bupivacaine (0.25: 0.30 mg/kg) + 30 mg tramadol hydrochloride. Group (BS) control that received hyperbaric 0.5% bupivacaine (0.25: 0.30 mg/kg) alone. Hemodynamic variables, sensory and motor block characteristics, VAS and complications were recorded.
Results: The MBP was significantly lower in tramadol group compared to fentanyl and control groups only in the first 30 minutes. Heart rate (HR), SPO₂ showed non-significant difference. Pruritus was most common in the tramadol group followed by the fentanyl. Nausea and vomiting were more common in opioid groups than control group. VAS was significantly higher in the control group immediately and till 12 hours postoperatively compared to opioid groups.
Conclusion: Both tramadol and fentanyl, when used as intrathecal adjuvants to bupivacaine, offered excellent postoperative analgesia for patients having infraumbilical operations compared to bupivacaine alone. Side effect profiles between the two opioid groups were similar.