Effects of postoperative intravenous infusion of tramadol and addition of dexmedetomidine to tramadol on analgesia and hemodynamic parameters in gynecologic surgery: a prospective (double blind) randomised controlled trial

Abstract

Aim: We designed this double-blind study to test and compare the effects of intravenous tramadol and intravenous tramadol plus dexmedetomidine on analgesia and hemodynamic parameters for treatment of postoperative pain in gynecologic surgeries with Pfannenstiel incision. Methods: Sixty patients undergoing total abdominal hysterectomy with Pfannenstiel incision under general anesthesia were randomly allocated into two groups. Group C (Tramadol) and Group D (Tramadol + Dexmedetomidin). The anesthetic technique was standardized. Postoperatively, the patients in both groups received patient controlled analgesia during 24 hours after surgery (tramadol 20 mg bolus for Group C, tramadol 20 mg+dexmedetomidine 10 mg first four hours, then tramadol 20 mg for Group D with a lock-out time of 15 minutes). Postoperative assessment included verbal pain score, sedation score, nausea and vomiting score, consumption of tramadol, hemodynamic parameters and patient’s satisfaction. Results: Postoperative pain scores were significantly lower in Group D compared with Group C and patientcontrolled analgesia tramadol use was significantly reduced in Group D. Total PCA tramadol use was decreased by 27% in Group D compared with Group C (p=0.001). Patient satisfaction with pain treatment was significantly improved in Group D compared with Group C (p=0.001). A significant increase in sedation scores at the 1st, 2nd and 4th hours were observed in Group D. Heart rate was lower in Group D at the 1st, 2nd and 4th hours postoperatively (p=0.001, p=0.001 and p=0.01, respectively). Nausea and vomiting score was lower in Group D (p<0.05 for all). Conclusion: The addition of dexmedetomidine to tramadol by patient controlled analgesia method significantly reduces tramadol consumption and increases analgesia level and patient satisfaction in gynecological operations.