Comparative hemodynamic advantages of subarachnoid administration of atypical and non-atypical opioids

Subarachnoid administration of opioids such as pethidine and fentanyl had been proven safe but that oftramadol has been controversial. Tramadol is cheap and readily available, hence the need to further evaluate its intrathecal safety.

The study aimed at determining the hemodynamic and side effect profile of intrathecal tramadol.

One hundred and eighty six (186) ASA I or II patients scheduled for emergency open appendicectomy under spinal anesthesia were included in the study. Group BF (n = 62) received intrathecal fentanyl 25 microg plus 3 ml of 0.5% hyperbaric bupivacaine, Group BS (n = 62) received 0.5 ml normal saline plus 3 ml of 0.5% hyperbaric bupivacaine and Group BT (n = 62) received intrathecal tramadol 25 mg plus 3 ml of 0.5% hyperbaric bupivacaine. Hemodynamic profile and side effects were monitored intraoperatively and 12 hours postoperatively.

Fifteen (24.2%), 13 (20.9%) and 15 (24.5%) patients respectively in Groups BF, BS and BT had hypotension (P = 0.886). The incidence of postoperative vomiting occurred in 2 patients (3.2%) in Group BF as compared to 3 patients (4.8%) in Group BS and 10 patients (16.1%) in Group BT (P = 0.016). No surgeon in Group BF reported dissatisfaction but 18 patients (29%) in Group BS and 1 patient (1.6%) in Group BT had their surgeons reporting dissatisfaction (P = 0.0001).

This study shows that intrathecal tramadol 25 mg has higher incidence of post operative nausea and vomitting than 25 microg of intrathecal fentanyl but both drugs were safe.