The effects of different doses of tramadol hcl added to levobupivacain on postoperative analgesia at supraclavicular brachial plexus blockade

Aim: In our study we aimed to research the effects of different doses of tramadol HCI added to levobupivacain on postoperative analgesia at supraclavicular brachial plexus blockade.Equipments and method: After the approval of faculty ethic committee and a writen informed consent taken from the patients, orthopedia patients who are going under upper extremity surgery and urology patients who are going under arteriovenous fistula surgery were taken in to the study and supraclavicular brachial plexus blockade was applied to the totaly 60 patients.Patients randomly divided into three groups.To group I patients %0,5 levobupivacain in 40 ml volume was applied. 0,5mg/kg tramadol HCl in the group II, and 1mg/kg tramadol HCl in the group III was added to the same doses and volumes of levobupivacain. Blockade was applied with supraclavicular technique by the (help) router of a peripheral nerve stimulator. After the application of technique, surgery starting time, sedation and analgesia levels (VAS,VRS) , preoperative,perioperative and postoperative hemodynamic parameters were recorded on (at) specified (determined) intervals as before the block and after the block 5,10,15,30,45,60,90,120th minutes .The patients are observed during the operation and at the postoperative recovery room for the development of nausea and vomitting,itch,breathing depression,pain and horner syndrome.We planned to give 4 mg Ondansetron i.v. to the patients with nausea and vomitting. Postoperative second day we visited and asked the patients when their pain has started. We suggested them to take orally tramadol HCl if the pain begins.At the 48th hour,pain starting time is asked and recorded. Datas were evaluated statistically by one way ANOVA and chi square test ,p<0,05 values were accepted as considerable (significant) differentiation expression.Findings: Groups? demographic data and hemodinamic parameters were found similar and statistically no significant difference is determined between them.Surgery starting time was 30.5 +/- 4.1 minutes in group I, 20.5 +/- 2.2 minutes in group II, 17.4+/- 2.6 minutes in group III .Statistically significant difference between three groups is determined (p<0,05) but no significant difference between group II and group III is determined (p>0,05).Statistically there was no significant difference between VAS,VRS and sedation values for both three groups during peroperative and postoperative periods. (p>0,05).Postoperative pain starting (administration) times were 8.7+/-1.4 hours in group I,12.2+/-0.5 hours in group II,and 16.3+/-2.1 hours in group III.Statistically significant difference between group I and group II-groupIII (p<0.05) is determined but no significant difference between group II and group III is detected (p>0,05).In our study we observed that surgery starting time was earlier and postoperative analgesia duration was longer in group II and group III than group I(p<0,05).Beside this there was no difference in surgery starting time and postoperative analgesia duration between group II and group III (p>0,05).Result: Consequently we found that;at supraclavicular brachial plexus blockade,with an addition of tramadol HCI 0,5 mg/kg and tramadol HCI 1 mg/kg to %0,5 levobupivacain can obtain earlier surgery starting time and longer postoperative analgesia duration.However there was no difference between doses of tramadol HCI 0,5 mg/kg and tramadol 1 mg/kg for surgery starting time and postoperative analgesia durationKey words: Levobupivacain,Postoperative analgesia,Supraclavicular brachial plexus blockade, Tramadol HCl,