RECTAL PREOPERATIVE TRAMADOL AND INTRAOPERATIVE BUPIVACAINE WOUND INFILTRATION AT CESAREAN DELIVERY FOR POSTOPERATIVE ANALGESIA

Abstract

Delivery by CS is increased and is one of the most common great operative procedures done worldwide. Prompt and adequate postoperative pain relief is an important issue of caesarean delivery. Pain relief may cause good psychological and physical effects in patients,lead to better recovery from surgical procedures and early mobilization of patients to prevent complications. Pain after operations is usually mannaged with opioids. These agents exert their analgesic effects through μ-receptors in the CNS. The effect of opioids is limited by the occurance of tolerance or side effects such as vomitin, nausea, sedation, or respiratory depression. Tramadol, is analgesic with weak mu-opioid receptor agonist and activity at serotonergic, noradrenergic and GABAergic systems, is another alternative parenteral ,oral and rectal analgesic for post caesarean pain. The local anesthetic may be used before or after abdominal nerve block, absorbed by systemic route and secreted in breast milk, but their effects on breast fed babies have not yet been demonstrated. This is in contrast to morphine or pethidine, both of which have significant transfer to breast milk and may have a sedative effect on the baby. Objectives: Of our study was to measure the effect of rectal tramadol and bupivacaine infiltration on pain relief after CS and on opioids requirement. Patients and methods: 312 parturient,scheduled for CS under general anashesia ,participated in this study, 156 parturient received placebo rectally and saline infiltration and the other 156 received Tramadol 100mg rectally and Bupivacaine 0.25% infiltration in the wound. Results: Rectal Tramadol and local Bupivacaine infiltration is effective in decreasing intensity of postoperative pain and the amount of the opioids consumption. Conclusion: Combination of the rectal Tramadol suppository and Bupovacaine infiltration of surgery wound cause longer duration of analgesia and decrease consumption of opiods. so can be a good choice for pain relief after cesarean delivery.
Key Words: Tramadol, bupivacaine, wound infiltration, cesarean delivery, postoperative analgesia.