A Comparative Study of Adverse Events Occuring after Epidural Suffentanil and Tramadol

Dr. Amit Hiwarkar¹, Dr. Manish Bhagwandas Kotwani² and Dr. Yogita Hiwarkar³

¹Assistant Professor, Department of Anaesthesiology, Dr. Ulhas Patil Medical College,Jalgaon Kh.

²Assistant Professor, Department of Anaesthesiology, LTMMC and LTMGH, Sion Mumbai.

³Assistant Professor, Department of Community Medicine, Dr. Ulhas Patil Medical College, Jalgaon Kh.

ABSTRACT:

The incidence of adverse events with group S (Sufentanil) was noted less in comparison to group T (Tramadol) and these occur in early phase of epidural administration. As far as pruritus was concerned higher incidence was noticed and it was observed on face, nose and anterior chest wall. Pruritus was not troublesome in any of the patients.

KEYWORDS: Adverse events, nausea, vomiting, pruritus and urinary retention.

INTRODUCTION:

It is found that cephalad spread of spinal opiods is associated with occurrence of side effects such as pruritus, nausea etc. Sufentanil results in a fewer and less severe adverse events. Tramadol is less lipid soluble as compared to sufentanil so more drug get access to CSF and shows cephalad movement. It acts on the chemoreceptor trigger zone in brain stem to initiate nausea and vomiting. Sufentanil being highly lipid soluble results in rapid clearance of drugs from CSF and shows less cephalad spread. This study was undertaken to analyse the adverse events noted during epidural administration of Sufentanil and Tramadol.

MATERIALS AND METHODS:

This study was prospective, randomized and double blind study carried out in adult female patients undergoing elective major gynecological surgeries under combined spinal epidural technique.

Study variables included were as follows:

· Nausea

· Vomoting

· Pruritus and

· Urinary retention

· Severity of the above variables was assessed according to scales as follows-

Nausea:

0 = None

1 = Mild

2 = Moderate to severe

Vomiting:

0 = None

1 = Single episode

2 = Multiple episode

Pruritus:

0 = None

1 = Mild

2 = Moderate/severe localised

3 = Mild generalized

4 = Moderate/severe generalized

Urinary retention = As far as urinary retention was concerned all cases had Foley’s catheter in-situ preoperatively hence incidence of urinary retention could not be recorded.

OBSERVATIONS AND DISCUSSION:

On analysis of the collected data it was noted that the incidence of nausea was found in 10% of cases in group S and 22.5 % in group T patients while vomiting was noted in 2.5 % in group S and 17.5% in group T cases (Table-I). These values were found to be statistically significant. Nausea/Vomiting was significantly more in tramadol group. On further analysis authors noted that incidence of pruritus was 2.5 % in T group in comparison to 20% in group S. This phenomenon was noted mostly in the first two hours of drug administration and body areas most commonly involved were as follows:

· Face

· Nose and

· Anterior chest wall

Pruritus was not troublesome in any of the patients.

As far as urinary retention was concerned it was to note that all cases had Foley’s catheter in-situ preoperatively hence incidence of urinary retention could not be recorded in any of the case of both groups.

Donadoni et al (1) reported that short lasting nausea in only one case which could be due to prior administration of anti emetic by the attending nurse while mild itching only in three patients. Madej et al (2) noted nausea and vomiting in 30 and 40 percent cases in group S cases. Mandej also observed that 90 percent of cases suffered pruritus.

Rosen et al (3) and Graff et al (4) found the incidence of nausea and vomiting in 20 percent cases in group S.Graff also noted pruritus in thirteen percent cases. The findings of the different authors were found more or less in accordance with the findings of the present study.

TABLE-I-PROFILE OF ADVERSE EVENTS IN BOTH THE GROUPS

EVENTS	SUFFENTANIL GROUP	TRAMADOL GROUP
NAUSEA	04 (10)	09 (22.5)
VOMITING	01 (02.5)	07 (17.5)
PRURITUS	08 (20.0)	01 902.5)
TOTAL NO. OF CASES	11 (27.5)	14 (35.0)

Figures in parenthesis indicate percentage

REFERENCES:

(1) Donadoni R, Rolly G, Noorudin H and Bussche GV. Epidural sufentanil for post operative pain relief. Anaesthesia 1985; 40: 634-638

(2) Madeg TH and Strunin L. Comparision of epidural sufentanil with fentanyl; Anaesthesia 1987; 42: 1156-1161

(3) Rosen M.A. et al Epidural sufentanil for post operative analgesia after caesarean section. Anaesthesia 1988; 68: 448-454

(4) Graff G et al Epidural sufentanil for post operative analgesia 1988; Anaesthesia Analgesia 1991; 73: 405-409

Received on 17.06.2013

Modified on 22.08.2013

Accepted on 10.09.2013

Research J. Pharmacology and Pharmacodynamics. 5(5): September–October 2013, 291-292