الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
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SUMMARY
Tramadol is a new Mu agonist drug has two different opioid and non-opioid effects. So, we evaluated its different anesthetic effects in our work.
The study was done in Benha university hospitals where we selected 120 patients, their age ranged between 20-60 years of both sexes according to ASA physical status I or II. All patients scheduled for elective abdominal surgery after complete clinical examinations and routine investigations. We obtained their informed consent and divided them into equal four groups.
In group I, tramadol was used as a pre-medication drug before induction of general anesthesia which divided into three equal subgroups (i.e. Ia intravenous, Ib intramuscular and Ic oral subgroups) according to route of administration.
In group II, tramadol was used as a component of balanced anesthesia to evaluate its effect on stress response compared with fentanyl which divided into two subgroups (Ha i.e. tramadol subgroup and Hb i.e fentanyl subgroup).
In-group III, 30 patients was studied to detect its systemic postoperative analgesic effect, which was divided according to route of administration into 3 equal subgroups (Ma i.e: PCA, Mb by intravenous drip route, IIIc through intramuscular route).
In-group IV, we used epidural technique for postoperative analgesia comparing tramadol with fentanyl and pethidine which was
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divided equally into three subgroups (IVa: using tramadol, IVb: using fentanyl and IVc: using pethidine).
Hemodynamics (ECG, FIR, MBP) and respiratory (RR, Blood oxygen saturation) parameters were monitored in various known times according to our work for all groups. Also, certain hormonal measurements (plasma cortisol level & plasma norepinephrine level) were done in group IL In group III and IV, the degree of pain relief by using (VRS) for 24 hour in postoperative period was evaluated, also any side effect was recorded for all groups.
from this study the following results were obtained :
In-group I and II, we found a significant increase in HR and MBP in response to induction of anesthesia, immediate after intubation and after skin incision. This response was similar in different routes of administration (I.V. I.M, Oral route) in premedication group. More over in balanced anesthesia group, both plasma cortisol level and plasma nor-adrenaline level were significantly increased at the same times comparing with fentanyl. This increases due to stress response of intubation & surgical manipulation.
This mean that tramadol has no significant effect on stress response of anesthesia and surgery. So, it is not a suitable drug when used as a premedication drug even if used with balanced anesthesia. The only advantage of tramadol in balanced anesthesia was reducing of the postoperative pain.
In-group III, when we used tramadol as a systemic postoperative analgesia, a significant decrease in pain score (analgesia) in postoperative
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time during monitoring was detected. This effect was equal after different routes of administration (PCA, I.V, and IM). Onset of action started after 5 minutes in PCA&I.V infusion but started after 30 minutes in IM. The total dose of consumption/24 hour was 257±77.76 mg, 475±42.49 mg and 240±61.46mg in (PCA, I.V infusion and IM, respectively). So, this means that tramadol has a systemic analgesic effect.
In-group IV, epidural tramadol has a significant analgesic effect, comparing with epidural fentanyl and epidural pethidine. By using verbal rating scale, pain score was significantly decreased after 15 minute (onset of action) and maximally decreased at 3,6 hour and 12 hour after repeated booster doses of epidural tramadol.
During hemodynamic monitoring, we founded that tramadol had no significant change in both HR and MBP after using it as a postoperative systemic analgesia in a different routes of administration. This mean that tramadol has no cardiovascular effects beside its potent analgesic effect if use as a postoperative systemic or epidural analgesia.
After continuous monitoring of respiratory rate and blood oxygen saturation by using pulse oximetry, we found that tramadol had no significant changes in respiratory rate and blood oxygen saturation which also not fall below 92%. It means that tramadol has no respiratory depression effect and so, can be used safely during postoperative period in recommended dose.
The side effects of tramadol can be summarized as nausea and/or vomiting, dizziness and sweating which were common in all studied groups.