Fentanyl with levobupivacaine versus tramadol with levobupivacaine for combined spinal epidural analgesia in labor

Background: Pain is perceived only by the sufferer as it is a subjective phenomenon. The TCIA (Taxonomy committee of International Association) defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. Aim: The present study was conducted to compare the efficacy of post-operative analgesia with epidural Tramadol in combination with levobupivacaine versus fentanyl. Materials and methods: This study was conducted study was a prospective, randomised comparative study. After ethical committee approval, a total of 100 patients were selected undergoing lower limb and lower abdominal surgeries were included in the study. Inclusion Criteria was patients who had ASA I and ASA II, age between 18-45 years, both males and female patients were included in the study. An informed consent was obtained from all the patients and they were examined thoroughly clinically during the pre-anaesthetic evaluation and routine laboratory investigations were done. 100 patients were allocated into two groups by simple randomisation technique. Group A: Tramadol and Levobupivacaine group (n=50) and Group B: Fentanyl group and Levobupivacaine (n=50). Results: In the present study, mean age in group I was 55.23±2.35, mean age in group II was 56.85±8.24, and male: female ratio was 18:10 in group I and in group II was 15:8. Duration of surgery in group I was 111.50 minutes and in group II was 112.85 minutes. Mean VAS score was less than 1 in both the groups was either equal to 1 or less than 1 during the first 24 hours after first dose of epidural analgesic administration. There was no significant difference in the mean heart rate among both the groups statistically (p>0.05). There was no significant difference in systolic and diastolic blood pressure among both the groups statistically (p>0.05). There was no significant difference in mean arterial blood pressure among both the groups statistically (p>0.05). More side effects were seen in group B i.e. fentanyl along with levobupivacaine. Conclusion: Prolonged analgesia with minimal side effects is provided by adding tramadol to local anesthetic. Fentanyl has certain fetomaternal side-effects, when used as adjuvant to local anesthetic, but it provides a rapid onset of analgesia.