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Effects of postoperative intravenous infusion of tramadol and addition of dexmedetomidine to tramadol on analgesia and hemodynamic parameters in gynecologic surgery: A prospective (double blind) randomised controlled trial

Year 2018, Volume: 3 Issue: 2, 88 - 93, 20.07.2018
https://doi.org/10.25000/acem.422550

Abstract
















Aim: We designed this
double-blind study to test and compare the effects of intravenous tramadol and
intravenous tramadol plus dexmedetomidine on analgesia and hemodynamic
parameters for treatment of postoperative pain in gynecologic surgeries with
Pfannenstiel incision.




Methods: Sixty patients undergoing total abdominal
hysterectomy with Pfannenstiel incision under general anesthesia were randomly
allocated into two groups. Group C (Tramadol) and Group D (Tramadol + Dexmedetomidin).
The anesthetic technique was standardized.
Postoperatively, the patients in both
groups received patient controlled analgesia during 24 hours after surgery
(tramadol 20 mg bolus for Group C, tramadol 20 mg+dexmedetomidine 10 mg first
four hours, then tramadol 20 mg for Group D with a lock-out time of 15 minutes).
Postoperative assessment included verbal pain score, sedation score, nausea and
vomiting score, consumption of tramadol, hemodynamic parameters and patient’s
satisfaction.




Results: Postoperative pain
scores were significantly lower in
Group D compared with Group C and patient-controlled analgesia
tramadol use was
significantly reduced in
Group D. Total PCA tramadol use was decreased by 27% in Group D compared with Group C (p=0.001).
Patient satisfaction with pain treatment was significantly improved in
Group D compared with Group C (p=0.001).
A
significant increase in sedation scores at
the 1st, 2nd and 4th
hours were observed in Group D. Heart rate was lower in Group D at the 1st, 2nd
and 4th hours postoperatively (
p=0.001, p=0.001 and p=0.01, respectively). Nausea and vomiting score was lower in Group D (p<0.05 for all).




Conclusion: The addition of dexmedetomidine to tramadol by patient controlled
analgesia method significantly reduces tramadol consumption and increases
analgesia level and patient satisfaction in gynecological operations.








References

  • 1. Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general andspinal anesthesia: a randomized clinical trial. Sao Paulo Med J. 2015;133:227-34.
  • 2. Schnabel A, Meyer-Frießem CH, Reichl SU, Zahn PK, Pogatzki-Zahn EM. Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials. Pain. 2013;154:1140-9.
  • 3. Cruickshank M, Henderson L, MacLennan G, Fraser C, Campbell M, Blackwood B, et al. Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review. Health Technol Assess. 2016; 20:v-xx, 1-117.
  • 4. Falzone E1, Hoffmann C, Keita H. Postoperative analgesia in elderly patients. Drugs Aging. 2013;30:81-90.
  • 5. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382-94.
  • 6. Fairbanks CA, Kitto KF, Nguyen HO, Stone LS, Wilcox GL. Clonidine and dexmedetomidine produce antinociceptive synergy in mouse spinal cord. Anesthesiology. 2009;110:638-47.
  • 7. Gil DW, Cheevers CV, Kedzie KM, Kedzie KM, Manlapaz CA, Rao S, et al. Alpha-1-adrenergic receptor agonist activity of clinical alpha-adrenergic receptor agonists interferes with alpha-2-mediated analgesia. Anesthesiology. 2009;110:401-17.
  • 8. Grosu I, Lavand'homme P. Use of dexmedetomidine for pain control. F1000 Med Rep. 2010;2:90.
  • 9. Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116:1312-22.
  • 10. Nelson S, Muzyk AJ, Bucklin MH, Brudney S, Gagliardi JP. Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit.Biomed Res Int. 2015;2015:635737.
  • 11. Peng K, Jin XH, Liu SL, Ji FH. Effect of Intraoperative Dexmedetomidine on Post-Craniotomy Pain. Clin Ther. 2015;37:1114-21.
  • 12. Zhang X, Wang R, Lu J, Jin W, Qian Y, Huang P, et al. Effects of different doses of dexmedetomidine on heart rate and blood pressure in intensive care unit patients. Exp Ther Med. 2016;11:360-6.
  • 13. Ickeringill M, Shehabi Y, Adamson H, Ruettimann U. Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: hemodynamic effects and efficacy. Anaesth Intensive Care 2004;32:741-5.
  • 14. Wang G, Zhang L, Lou S, Chen Y, Cao Y, Wang R, et al. Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis (PRISMA). Medicine (Baltimore). 2016;95:e2927.
  • 15. Cormack JR, Orme RM, Costello TG, The role of alpha–2-agonists in neurosurgery. J Clin Neurosci. 2005;12:375-8.
  • 16. Cortinez LI, Hsu YW, Sum-Ping ST, Young C, Keifer JC, Macleod D. Dexmedetomidine pharmacodynamics: Part II: Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004;101:1077-83.
  • 17. Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009;30:1537-41.
  • 18. Al-Zaben KR, Qudaisat IY, Al-Ghanem SM, Massad IM, Al-Mustafa MM, Al-Oweidi AS, et al. Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery. Eur J Anaesthesiol. 2010;27:247-52.
  • 19. Gandhi KA, Panda NB, Vellaichamy A, Mathew PJ, Sahni N, Batra YK. Intraoperative and Postoperative Administration of Dexmedetomidine Reduces Anesthetic and PostoperativeAnalgesic Requirements in Patients Undergoing Cervical Spine Surgeries. J Neurosurg Anesthesiol. 2016 Mar 31. [Epub ahead of print]
  • 20. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.
  • 21. Hall JE, Uhrich TD, Ebert TJ. Sedative, analgesic and cognitive effects of clonidine infusions in humans. Br J Anaesth. 2001;86:5-11.
  • 22. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major ınpatient surgery. Anesth Analg. 2004;98:153-8.
  • 23. Lin TF, Yeh YC, Lin FS, Wang YP, Lin CJ, Sun WZ, et al. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia. Br J Anaesth. 2009;102:117-22.
  • 24. Unlugenc H, Gunduz M, Guler T, Yagmur O, Isik G. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol. 2005;22:386-91.
  • 25. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit, Anaesthesia. 1999;54:1136-42.
  • 26. De Kock MF, Pichon G, Scholtes JL. Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia. Can J Anaesth. 1992;39:537-44.
  • 27. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002;95:461-6.
  • 28. Whittington RA, Virág L. Dexmedetomidine-induced decreases in accumbal dopamine in the rat are partly mediated via the locus ceruleus. Anesth Analg. 2006;102:448-55.
  • 29. Abdelmageed WM, Elquesny KM, Shabana RI, Abushama HM, Nassar AM. Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Saudi J Anaesth. 2011; 5: 150-6.
  • 30. Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. 2008;25:22-8.

Jinekolojik cerrahide postoperatif uygulanan intravenöz tramadolün ve tramadole deksmedetomidin ilavesinin analjezi ve hemodinamik parametreler üzerine etkileri: Prospektif (çift kör) randomize kontrollü çalışma

Year 2018, Volume: 3 Issue: 2, 88 - 93, 20.07.2018
https://doi.org/10.25000/acem.422550

Abstract




Amaç: Bu çalışmada Pfannenstiel kesisi yapılan jinekolojik prosedürlerde
postoperatif ağrı tedavisinde intravenöz tramadol ile intravenöz tramadole
ilave deksmedetomidinin analjezi ve hemodinamik parametreler üzerine etkilerinin
karşılaştırılması amaçlanmıştır.




Yöntemler: Genel anestezi altında elektif Pfannenstiel kesisi uygulanarak
jinekolojik operasyon planlanan ASA I-II grubuna dahil 60 hasta randomize
olarak iki gruba ayrıldı (Grup C (Tramadol grubu) ve Grup D Tramadol +
Deksmedetomidin). Operasyon sonrası derlenme odasına alınan her iki gruptaki
hastalara ameliyat sonrası 24 saat boyunca hasta
kontrollu analjezi (HKA) 
uygulandı (Grup C için 20 dk kilitli
kalma süresi ile 20 mg tramadol bolus doz, Grup D için ilk 4 saat 20 mg
tramadol+10mcg deksmedetomidin bolus doz, daha sonra 20 mg tramadol bolus doz).
Postoperatif değerlendirmede, sözel ağrı skoru, sedasyon skoru, bulantı ve
kusma skoru, tramadol kullanımı ile hemodinamik parametreler ve hasta
memnuniyeti kaydedildi.




Bulgular:
Postoperatif ağrı skorları Grup D'de, Grup C'ye göre anlamlı olarak düşüktü ve
hasta kontrollü analjezi tramadol kullanımı Grup D'de anlamlı olarak azaldı.
Toplam PCA tramadol kullanımı Grup D'de Grup C ile karşılaştırıldığında % 27
azaldı (p=0,001). Ağrı tedavisi ile hasta memnuniyeti Grup D'de Grup C'ye göre
anlamlı olarak yükseldi (p=0,001). Grup D'de 1, 2 ve 4 saatte sedasyon
skorlarında anlamlı bir artış gözlendi. Kalp hızı, Grup D'de postoperatif 1, 2
ve 4 saatte daha düşüktü (sırası ile
p=0,001, p=0,001 and p=0,01, respectively). Bulantı ve kusma skoru Grup D'de daha düşüktü (hepsi için p<0,05).



Sonuç: Deksmedetomidinin PCA yöntemiyle tramadole eklenmesi, tramadol
tüketimini önemli ölçüde azaltmakta ve jinekolojik operasyonlarda analjezi
düzeyini ve hasta memnuniyetini artırmaktadır.

References

  • 1. Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general andspinal anesthesia: a randomized clinical trial. Sao Paulo Med J. 2015;133:227-34.
  • 2. Schnabel A, Meyer-Frießem CH, Reichl SU, Zahn PK, Pogatzki-Zahn EM. Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials. Pain. 2013;154:1140-9.
  • 3. Cruickshank M, Henderson L, MacLennan G, Fraser C, Campbell M, Blackwood B, et al. Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review. Health Technol Assess. 2016; 20:v-xx, 1-117.
  • 4. Falzone E1, Hoffmann C, Keita H. Postoperative analgesia in elderly patients. Drugs Aging. 2013;30:81-90.
  • 5. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382-94.
  • 6. Fairbanks CA, Kitto KF, Nguyen HO, Stone LS, Wilcox GL. Clonidine and dexmedetomidine produce antinociceptive synergy in mouse spinal cord. Anesthesiology. 2009;110:638-47.
  • 7. Gil DW, Cheevers CV, Kedzie KM, Kedzie KM, Manlapaz CA, Rao S, et al. Alpha-1-adrenergic receptor agonist activity of clinical alpha-adrenergic receptor agonists interferes with alpha-2-mediated analgesia. Anesthesiology. 2009;110:401-17.
  • 8. Grosu I, Lavand'homme P. Use of dexmedetomidine for pain control. F1000 Med Rep. 2010;2:90.
  • 9. Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116:1312-22.
  • 10. Nelson S, Muzyk AJ, Bucklin MH, Brudney S, Gagliardi JP. Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit.Biomed Res Int. 2015;2015:635737.
  • 11. Peng K, Jin XH, Liu SL, Ji FH. Effect of Intraoperative Dexmedetomidine on Post-Craniotomy Pain. Clin Ther. 2015;37:1114-21.
  • 12. Zhang X, Wang R, Lu J, Jin W, Qian Y, Huang P, et al. Effects of different doses of dexmedetomidine on heart rate and blood pressure in intensive care unit patients. Exp Ther Med. 2016;11:360-6.
  • 13. Ickeringill M, Shehabi Y, Adamson H, Ruettimann U. Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: hemodynamic effects and efficacy. Anaesth Intensive Care 2004;32:741-5.
  • 14. Wang G, Zhang L, Lou S, Chen Y, Cao Y, Wang R, et al. Effect of Dexmedetomidine in Preventing Postoperative Side Effects for Laparoscopic Surgery: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis (PRISMA). Medicine (Baltimore). 2016;95:e2927.
  • 15. Cormack JR, Orme RM, Costello TG, The role of alpha–2-agonists in neurosurgery. J Clin Neurosci. 2005;12:375-8.
  • 16. Cortinez LI, Hsu YW, Sum-Ping ST, Young C, Keifer JC, Macleod D. Dexmedetomidine pharmacodynamics: Part II: Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004;101:1077-83.
  • 17. Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J. 2009;30:1537-41.
  • 18. Al-Zaben KR, Qudaisat IY, Al-Ghanem SM, Massad IM, Al-Mustafa MM, Al-Oweidi AS, et al. Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery. Eur J Anaesthesiol. 2010;27:247-52.
  • 19. Gandhi KA, Panda NB, Vellaichamy A, Mathew PJ, Sahni N, Batra YK. Intraoperative and Postoperative Administration of Dexmedetomidine Reduces Anesthetic and PostoperativeAnalgesic Requirements in Patients Undergoing Cervical Spine Surgeries. J Neurosurg Anesthesiol. 2016 Mar 31. [Epub ahead of print]
  • 20. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.
  • 21. Hall JE, Uhrich TD, Ebert TJ. Sedative, analgesic and cognitive effects of clonidine infusions in humans. Br J Anaesth. 2001;86:5-11.
  • 22. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major ınpatient surgery. Anesth Analg. 2004;98:153-8.
  • 23. Lin TF, Yeh YC, Lin FS, Wang YP, Lin CJ, Sun WZ, et al. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia. Br J Anaesth. 2009;102:117-22.
  • 24. Unlugenc H, Gunduz M, Guler T, Yagmur O, Isik G. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol. 2005;22:386-91.
  • 25. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit, Anaesthesia. 1999;54:1136-42.
  • 26. De Kock MF, Pichon G, Scholtes JL. Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia. Can J Anaesth. 1992;39:537-44.
  • 27. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg. 2002;95:461-6.
  • 28. Whittington RA, Virág L. Dexmedetomidine-induced decreases in accumbal dopamine in the rat are partly mediated via the locus ceruleus. Anesth Analg. 2006;102:448-55.
  • 29. Abdelmageed WM, Elquesny KM, Shabana RI, Abushama HM, Nassar AM. Analgesic properties of a dexmedetomidine infusion after uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Saudi J Anaesth. 2011; 5: 150-6.
  • 30. Goksu S, Arik H, Demiryurek S, Mumbuc S, Oner U, Demiryurek AT. Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia. Eur J Anaesthesiol. 2008;25:22-8.
There are 30 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Research
Authors

Hakan Emirkadı This is me

Hüseyin Şen This is me

Güner Dağlı This is me

Bulat Aytek Şık

Yaşam Kemal Akpak

Publication Date July 20, 2018
Published in Issue Year 2018 Volume: 3 Issue: 2

Cite

Vancouver Emirkadı H, Şen H, Dağlı G, Şık BA, Akpak YK. Effects of postoperative intravenous infusion of tramadol and addition of dexmedetomidine to tramadol on analgesia and hemodynamic parameters in gynecologic surgery: A prospective (double blind) randomised controlled trial. Arch Clin Exp Med. 2018;3(2):88-93.