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REGIONAL ANESTHESIA

Tramadol Added to 1.5% Mepivacaine for Axillary Brachial Plexus Block Improves Postoperative Analgesia Dose-Dependently

Sébastien Robaux, MD^*, Cornelia Blunt, FRCA^*, Eric Viel, MD, Philippe Cuvillon, MD, Philippe Nouguier, MD^*, Gilles Dautel, MD, Sylvie Boileau, MD^*, Florence Girard, MD, and Hervé Bouaziz, MD, PhD^*

*Department of Anesthesiology and Critical Care Medicine, Hôpital Central, Nancy Cedex, the Department of Anesthesiology and Pain Management, Hôpital Caremeau, Nimes Cedex 9, France, the Department of Plastic and Hand Surgery, Hôpital Jeanne d’Arc, Nancy, France, and the Department of Clinical Epidemiology and Evaluation, Hôpital Marin, Nancy Cedex, France

Address correspondence and reprint requests to Hervé Bouaziz. Address email to h.bouaziz{at}chu-nancy.fr

Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T₄₀, n = 22), tramadol 100 mg (Group T₁₀₀, n = 20) or tramadol 200 mg (Group T₂₀₀, n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T₄₀ groups compared with the T₂₀₀ group. No statistical significance was demonstrated between the placebo and the T₄₀ group or the T₁₀₀ group and the T₂₀₀ group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice.

IMPLICATIONS: Tramadol’s unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.

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