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Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section

Received: 16 December 2023     Accepted: 2 January 2024     Published: 18 January 2024
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Abstract

Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 1)
DOI 10.11648/j.ijacm.20241201.11
Page(s) 1-6
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Wound Infiltration, Bupivacaine, Ketamine, Tramadol, Caesarean Section

References
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Cite This Article
  • APA Style

    Ajiboye, O. O., Osebequin, A. W., Edith, A., Olugbade, O. S., Joseph, A., et al. (2024). Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. International Journal of Anesthesia and Clinical Medicine, 12(1), 1-6. https://doi.org/10.11648/j.ijacm.20241201.11

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    ACS Style

    Ajiboye, O. O.; Osebequin, A. W.; Edith, A.; Olugbade, O. S.; Joseph, A., et al. Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. Int. J. Anesth. Clin. Med. 2024, 12(1), 1-6. doi: 10.11648/j.ijacm.20241201.11

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    AMA Style

    Ajiboye OO, Osebequin AW, Edith A, Olugbade OS, Joseph A, et al. Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. Int J Anesth Clin Med. 2024;12(1):1-6. doi: 10.11648/j.ijacm.20241201.11

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  • @article{10.11648/j.ijacm.20241201.11,
      author = {Olayinka Olumide Ajiboye and Adeyemi William Osebequin and Agu Edith and Olateju Simeon Olugbade and Achi Joseph and Oyewole Ezekiel},
      title = {Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {12},
      number = {1},
      pages = {1-6},
      doi = {10.11648/j.ijacm.20241201.11},
      url = {https://doi.org/10.11648/j.ijacm.20241201.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241201.11},
      abstract = {Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section
    AU  - Olayinka Olumide Ajiboye
    AU  - Adeyemi William Osebequin
    AU  - Agu Edith
    AU  - Olateju Simeon Olugbade
    AU  - Achi Joseph
    AU  - Oyewole Ezekiel
    Y1  - 2024/01/18
    PY  - 2024
    N1  - https://doi.org/10.11648/j.ijacm.20241201.11
    DO  - 10.11648/j.ijacm.20241201.11
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 1
    EP  - 6
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ijacm.20241201.11
    AB  - Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.
    
    VL  - 12
    IS  - 1
    ER  - 

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Author Information
  • Department of Anaesthesia, Garki Hospital Abuja, Abuja, Nigeria

  • Department of Anaesthesia, Federal Teaching Hospital, Lokoja, Nigeria

  • Department of Anaesthesia, Federal Teaching Hospital, Lokoja, Nigeria

  • Department of Anaesthesia and Intensive Care, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria

  • Department of Anaesthesia, University of Nigeria Teaching Hospital, Enugu, Nigeria

  • Department of Anaesthesia, Federal Teaching Hospital, Lokoja, Nigeria

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