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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Tramadol Added to Mepivacaine Prolongs the Duration of an Axillary Brachial Plexus Blockade

Stephan Kapral, MD^*, Gabriele Gollmann, MD, Barbara Waltl, MD^*, Rudolf Likar, MD, Robert N. Sladen, MD^§, Christian Weinstabl, MD^*, and Franz Lehofer, MD

*Department of Anesthesia and General Intensive Care, University of Vienna, Vienna; Department of Anesthesia, DOKH Friesach; Department of Anesthesia and General Intensive Care, LKH Klagenfurt, Klagenfurt, Austria; and §Department of Anesthesiology, Columbia-Presbyterian Medical Center, New York, New York

Address correspondence and reprint requests to Stephan Kapral, MD, Department of Anesthesia and General Intensive Care, University of Vienna, 18-20, Waehringer Guertel, A-1090 Vienna, Austria. Address e-mail to Stephan.Kapral{at}univie.ac.at

Tramadol is an analgesic drug that is antagonized by ₂-adrenoceptor antagonists, as well as opioid antagonists. We hypothesized that tramadol might produce effects on an axillary brachial plexus blockade similar to those of clonidine. We designed a prospective, controlled, double-blinded study to assess the impact of tramadol added to mepivacaine on the duration of an axillary brachial plexus blockade. After institutional approval and informed consent, 60 patients (ASA physical status I or II) scheduled for forearm and hand surgery after trauma under brachial plexus anesthesia were included in the study. Patients were randomly assigned to receive either 40 mL of mepivacaine 1% with 2 mL of isotonic sodium chloride solution (Group A, n = 20); 40 mL of mepivacaine 1% with 100 mg of tramadol (Group B, n = 20); or 40 mL of mepivacaine 1% with 2 mL of isotonic sodium chloride solution and 100 mg of tramadol IV (Group C, n = 20). Sensory block, motor block, and hemodynamics were recorded before and 5, 10, 30, 60, 120, 180, and 360 min after local anesthetic injection. Duration of sensory and motor block was significantly longer (P < 0.01; P < 0.05) in Group B (299 ± 84 and 259 ± 76 min) than in Group A (194 ± 35 and 181 ± 24 min) and Group C (187 ± 35 and 179 ± 16 min). There was no difference in onset of sensory and motor blockade among groups. Hemodynamics remained unchanged in all patients throughout the study period. We conclude that the addition of tramadol prolongs the duration of brachial plexus block without side effects. Tramadol may be an alternative to epinephrine or clonidine as an adjuvant to local anesthesia for an axillary block.

Implications: This study demonstrates that the admixture of 100 mg of tramadol with mepivacaine 1% for brachial plexus block provides a pronounced prolongation of blockade without side effects. Our data support a specific analgesic effect of tramadol on peripheral nerves.

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