Effect of addition of tramadol to lidocaine for intravenous regional anaesthesia

Summary and conclusionThis study was carried out on sixty patients of either sex undergoing soft tissue and orthopedic surgical operations on the upper limbs in Zagazig university hospitals.The patients were classified into three groups of twenty patients each:Group I: Patients of this group were received 40 ml of tramadol 0.25%.Group II: Patients of this group were received 40 ml of lidocaine 0.5%.Group III: Patients of this group were recieved 40 ml of a mixture of lidocaine 0.5% and tramadol 0.25% (100 mg).The double tourniquet technique was used and exsanguination was performed by an Esmarch bandage after the gravitational drainage, then anaesthetic agent was injected in a previously inserted canula in the dorsum of the hand. In each group, we studied the onset, duration and offset of sensory and motor block.At the end of the operation, the tourniquet was released slowly .The following results were obtained :- Significant decrease in the mean time of onset of sensory loss between the three groups.- Significant decrease in the mean time of onset of motor loss between the three groups.- Significant increase in the duration of sensory and motor block in group III than group II and group I.- Significant increase in the duration of residual analgesia and residual motor loss in group III as compared to group II.In conclusion, tramadol 0.25% does not have local anaesthetic effect when used as a sole drug for IVRA. A local anaesthetic effect using a larger concentrations cannot be excluded, but possible secondary effects of toxic doses may limit it s use in clinical practice . However the present study suggests that tramadol may modify the action of a local anaesthetic providing a shorter onset time of sensory and motor block, increasing the duration of sensory and motor block and increasing the duration of residual analgesia and motor loss.