Efficacy of Ketamine Hcl and Tramadol Hcl by epidural route for lower abdominal surgeries
Keywords:Efficacy, Epidural, Ketamine, Surgeries, Tramadol
Background: Pain pathway has profound implications for management of acute pain and provoked interest in the use of pre-emptive analgesia and new methods of postoperative pain management with new agents like opioid and non-opioid drugs either independently or in combination. The objective of the study was to study efficacy of Ketamine Hcl and Tramadol Hcl (preservative free) by epidural route for lower abdominal surgeries.
Methods: This study has been conducted on hundred patients in the age group of 20 to 50 years. These patients have undergone various lower abdominal surgeries, gynecological and surgical procedures. Failed epidurals, catheter kinking, catheter migration and dural puncture cases are excluded from the study. The patients were divided into two groups namely Group-A and Group-B, with 50 patients in each group.
Results: Both groups were similar in terms of age, sex and weight. In Group-A patients who received 30 mg of Ketamine, the mean time of onset of analgesia being 17.01+2.65 minutes compared to 12.18+2.28 minutes in Group -B patients who received 100 mg of tramadol, In Group-A the mean time of duration of analgesia is 6.75+0.46 hours compared to 9.36+0.84 hours in Group-B. Nausea and vomiting (24% vs. 2%), urinary retention (4% vs. 2%) was more in group B compared to group A patients. Backache was equal in both the group patients (6% vs. 6%). Pain on injection more in group A patients i.e. 8% compared to only 2% in patients who belonged to group B.
Conclusions: Epidural tramadol is superior to epidural ketamine for postoperative pain relief.
Corssen G, Domino EF. Dissociative anesthesia: Further pharmacologic studies and first clinical experience with the phencyclidine derivative Cl-581. Anesthesia Analgesia. 1966;45(1):29-40.
Vincent JP, Kartalovski B, Geneste P, Kamenka JM, Lazdunski M. Interaction of phencyclidine (angel dust) with a specific receptor in rat brain membranes. Proceedings National Acad Sci. 1979;76(9):4678-82.
Ogawa A, Uemura M, Kataoka Y, Ol K, Inokuchi T. Effects of ketamine on cardiovascular responses mediated by N-methyl-D-aspartate receptor in the rat nucleus tractus solitarius. Anesthesiol. 1993;78(1):163-7.
Zsigmond EK. Diazepam for prevention of the rise in plasma catecholamines caused by ketamine. Clin Pharmacol Ther. 1974;15:223-4.
Spotoft H, Korshin JD, Søjrensen MB, Skovsted P. The cardiovascular effects of ketamine used for induction of anaesthesia in patients with valvular heart disease. Canadian Anaesthetists Soc J. 1979;26(6):463-7.
Naguib M, Adu-Gyamfi Y, Absood GH, Farag H, Gyasi HK. Epidural ketamine for postoperative analgesia. Canadian Anaesthetists Soc J. 1986;33(1):16-21.
Abdel-ghaffar ME, Abdulatif M, Al-ghamdi A, Mowafi H, Anwar A. Epidural ketamine reduces postoperative epidural PCA consumption of fentanyl/bupivacaine. Survey Anesthesiol. 1999;43(1):44-5.
Gebhardt B. Pharmacology and clinical results with peridural and intrathecal administration of ketamine. Der Anaesthesist. 1994;43:S34-40.
Delilkan AE, Vijayan R. Epidural tramadol for postoperative pain relief. Anaesthesia. 1993;48(4):328-31.
Islas JA, Astorga J, Laredo M. Epidural ketamine for control of postoperative pain. Anesthesia Analg. 1985;64(12):1161-2.
Vander AD, Verborgh C, Camu F. Epidural ketamine for postoperative analgesia. Anaesth Analg. 1987;66:1337
Kumar D, Gupta D. Comparative study of epidural buprenorphine and ketamine for post-operative pain relief. Ind J Anaesthesia. 1997;41:38-49.
Pedraz JL, Lanao JM, Calvo MB, Muriel C, Hernandez-Arbeiza J, Dominguez-Gil A. Pharmacokinetic and clinical evaluation of ketamine administered by iv and epidural routes. Int J Clinic Pharmacol Therapy Toxicol. 1987;25(2):77-80.
Shigihara A, Suzuki M, Kumada Y, Akama Y, Tase C, Okuaki A. Use of ketamine combined with local anesthetics in epidural anesthesia. Masui. Japanese J Anesthesiol. 1995;44(4):583-7.
Fu YP, Chan KH, Lee TK, Chang JC, Daiy YP, Lee TY. Epidural tramadol for postoperative pain relief. Anaesthesiol Sinica. 1991;29(3):648-52.
Prosser DP, Davis A, Booker PD, Murray A. Caudal tramadol for postoperative analgesia in pediatric hypospadias surgery. Brit J Anaesthesia. 1997;79(3):293-6.