The efects of postoperatively added dexmedetomidine to tramadole in patients with coronary artery bypass greft surgery

The aim of this study was to compare the effects of tramadole and tramadole-dexmedetomidine combinations on the pain control, sedation, hemodynamics and respiratory functions. Total of 40 adult patients scheduled for elective coronary arterial by-pass greft surgery (CABG) were enrolled to study. Patients were aged between 18 and 80 years old and all were in ASA II-III status. The surgical procedures were done in routinely. Postoperatively we applied the patient controlled analgesia (PCA) device for analgesic management. Patients were randomized into two groups. All patients received tramadole 50 mg initially. In Group I (Tramadole group) after initial dose, PCA was programmed to 5mg/kg infusion and 5 mg bolus dose with a 20 minutes lock-out period, and continued for 24 hours. In Group II (tramadole-dexmedetomidine group) patients received same doses of tramadole and additionally dexmedetomidine (0.4 µg/kg/h) for 24 hours. We reduced tramadole infusion to half dose when VAS score was 5 or lower. The hemodynamic variables, blood oxygen status, pain and sedation scores, pulmonary functions and adverse effects were recorded for 24 hours in the postoperative period. In Group II the resting period pain scores were statistically lower at the 1st, 8th, 12th, 16th, 20th and 24th hours after extubation; coughing pain scores were lower at 2nd, 4th, 8th, 12th, 16th, 20th and 24th hours after extubation; and sedation scores were higher at 1st, 2nd, 4th, 8th and 12th hours after extubation (p<0.05). The hemodynamic variables (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) were lower in tramadole-dexmedetomidine group at 2nd, 4th, 8th, 12th, 16th, 20th and 24th hours postoperatively (p<0.05). Total tramadole consumption and analgesic need were significantly lower in Group II. Dry mouth as an adverse effect was higher in Group II. Pulmonary function tests were similar between groups. In this study, we achieved a successful pain management and reduced tramadole consumption with addition of dexmedotomidine to tramadole. We also concluded that dexmedetomidine could support a satisfactory sedative effect without severe hemodynamic and respiratory adverse effects so it may be a potential and safe adjuvant agent for postoperative pain management in open heart surgery.Key words: PCA, Dexmedetomidine, Tramadol, CABG, Respiratory function tests.