الفهرس 
Anatomy, Physiology and Innervation ofOnly 14 pages are availabe for public view
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Abstract
Epidural analgesia using different local anesthetic-opioid combinations is a widely used technique for postoperative pain relief after major abdominal and pelvic operations. However, potentially serious adverse effects of epidural opioids as respiratory depression may create some boundaries to their liberal use. Attempts to overcome these problems have lead to the search for newer opioids with fewer side effects.
Tramadol is a synthetic analogue of codeine with moderate affinity at the µ-opioid receptors. In addition it has non-opioid mechanisms of analgesia by inhibition of noradrenaline reuptake and stimulation of serotonin release. These complementary mechanisms result in an opioid with potent analgesia but with a striking lack of respiratory depressant effect.
The aim of this study was to determine the efficiency and safety of epidural analgesia by using bupivacaine alone, tramadol alone and their combination, in order to reach an optimal combination of bupivacaine-tramadol dosage for postoperative epidural analgesia following transurethral prostatectomy using lower concentrations of each drug.
After approval of the departmental ethical committee, informed consents were obtained from sixty patients who were scheduled for transurethral prostatectomy. The patients were aged 55 to 65 years, of ASA physical status I or II, and average height and weight. All patients received anesthesia using the combined spinal epidural technique. The surgery was conducted using spinal anesthesia by 15 mg of hyperbaric bupivacaine. Following the surgery the patients were randomly allocated into one of three groups, 20 patients each according to the study drug injected into the epidural space. Postoperative epidural analgesia was started once the patients reached a visual analogue score of 4.
Group B (Bupivacaine): received an initial bolus dose of 10 ml bupivacaine 0.25% followed by top up doses of 8 ml 0.25% bupivacaine every two hours.
Group T (Tramadol): received an initial bolus of 50 mg tramadol in 10 ml normal saline followed by top up doses of 20 mg tramadol in 8 ml normal saline every two hours.
Group BT (Bupivacaine-Tramadol): received an initial bolus dose of 25 mg tramadol mixed with 10 ml of 0.125% bupivacaine, followed by top up doses of 10 mg tramadol mixed with 8 ml bupivacaine 0.125% every two hours.
Rescue analgesia (30 mg ketorolac in 100 ml normal saline) was given if the patients complained of inadequate analgesia, in spite of the epidural analgesia given.