[Adiuvants in the axillary brachial plexus blockade. Comparison between clonidine, sufentanil and tramadol]

Abstract

Background: Evaluated effects of tramadol used as adiuvant in brachial plexus block and compared with clonidine and sufentanil.

Methods: Randomized, prospectic study with 80 patients, ASA status I-II, undergoing carpal tunnel release performed under axillary plexus block with ropivacaine 0.75% 20 ml divided in 4 study groups: tramadolo 100 mg (Group T), clonidina 1.5 g/kg (Group C), sufentanil 20 g (Group S) in 5 ml. of NaCl. Control (Group F) NaCl 5 ml. Adeguacy of the block was evaluated using pinprick test ( three points scale) and a temperature test. Onset time, duration of analgesia and anesthesia were recorded. Also during the surgery the sedation score on a five-point scale was evaluated and were recorded episodes of hypotension, bradycardia, Sp02<90% and other side effects. Results are reported as median+/-SD. For statistical analysis ANOVA test, Bonferroni test and c2 test were used.

Results: Onset time of anesthesia showed significant difference between three study groups than control group, while no significant differences was recordered between groups S, C and T (S: 11+/-7 min; C: 12+/-4 min; T: 14+/-8 min; F: 20+/-11 min.). Same results were obtained among duration of anesthesia and analgesia, that were lower in F group. An adeguate quality of block for surgery was obtained in 79 patients. Only one patients of F group needed surgical infiltration. A significant difference was recordered among quality of anesthesia between group F and other three study groups. Highest sedation score was noted in C and S groups. Significantly highest incidence of bradycardia and hypotension episodes were observed in group C.

Conclusions: The use of tramadol as adiuvant provides a significative redution of onset time. Also provides a prolongation of anesthesia and analgesia with a quality of block similar that obtained with clonidine and sufentanil and a lower incidence of side effects of clonidine (sedation, bradycardia and hypotension) and sufentanil(itch and sedation). We conclude that tramadol may be a useful alternative, as adiuvant in periferic block, with same effects of other drugs commonly used and a lower incidence of side effects.