الفهرس 
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Abstract
This work had been carried out at the Anaesthesiology Department, El-Minia University hospital, in the period from November (2007) to April (2008).
The aim of this study is to compare post operative analgesic efficacy and side effects of adding intrathecal tramadol to bupivacaine with that of bupivacaine alone for haemorrhoidectomy.
The study included 40 patients who scheduled to undergo haemorrhoidectomy under spinal anaesthesia with saddle block and fulfill the inclusion criteria.
The patients included in the study were prospectively assigned in a double blind fashion (neither the administrator of the drug nor the patient knew the nature of the drugs given) and were allocated randomly to 2 groups 20 patients in each group, patients in group (B) received intrathecally 10mg of 0.5% heavy bupivacaine plus 0.5 ml of 0.9 saline while patients in group (BT) received intrathecally 10mg of 0.5% heavy bupivacaine plus tramadol 25mg 0.5ml.
Preoperative assessment and preparation of the patients were done by careful history taking, general, physical examination and routine preoperative investigation.
We assessed the visual analogue scale (VAS), each half an hour and for six hours during the post operative period. Also amount of analgesic requirement after operation and time to the first analgesic dose were assessed.
Sedation scale was measured each an hour and for six hours during the post operative period.
We assessed haemodynamic changes, O2 saturation preoperative and during operation, Also side effects were detected in the two groups.
Results were expressed as mean ±standard deviation (±SD) comparison between both groups was done using student’s t-test (paired t-test) inside the group and (unpaired t-test) between 2 groups for parametric data, while Chi-square test for non-parametric data.
Comparison between the two groups as regards age, height, weight, sex distribution and ASA status showed that no significant differences were present.
VAS was significantly higher in group B than in group BT and the total requirement of ketolac was also significantly less in group BT (30 ±0 mg) than in group B (41±9.2 mg), p value = 0.0001.
Time to the first analgesic requirement in the postoperative period was significantly prolonged in group BT (4.8 ±1.3 hours) while it was (2.4±0.1 hours) in the control group, p value= 0.0001.
There was no statistically significant difference between both groups as regard to sedation score.
No significant statistical difference was found when comparing the two groups as regards heart rate, mean blood pressure at different intervals.
No statistically significant differences were observed between both groups as regard to arterial O2 saturation, no patient in either group suffered respiratory depression.
There was no significant difference between the two studied groups regarding intraoperative and postoperative side effects except nausea in one patient and urine retention in other patient belong to group BT while only one patient belongs to group B suffered from headache.
Thus, our results supported the addition of intrathecal tramadol to bupivacaine in spinal anaesthesia for pain management after haemorrhoidectomy.