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CLINICAL INVESTIGATION
Year : 2008  |  Volume : 52  |  Issue : 2  |  Page : 164-169

Acute Post Mastectomy Pain: A Double Blind Randomised Controlled Trial: Intravenous Tramadol Vs Bupivacaine Irrigation through Surgical Drains


1 Senior Consultant and Coordinator, Department of Anesthesiology, ICU, Pain & Palliative Care Medicine, Jaipur, India
2 Consultant Anaesthesiologist, Department of Anesthesiology, ICU, Pain & Palliative Care Medicine, Jaipur, India
3 Senior Consultant, S.K. Soni Hospital, Jaipur, India
4 Senior Consultant and Coordinator, Department of Surgical Oncology Bhagwan Mahaveer Cancer Hospital & Research Centre , Jaipur, India

Correspondence Address:
Anjum S KhanJoad
Senior Consultant & Coordinator, Department of Anesthesiology, ICU and Pain & Palliative medicine, Bhagwan Mahaveer Cancer Hospital and Research Centre, J.L.N. Marg, Malviya Nagar, Jaipur-302017
India
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Source of Support: None, Conflict of Interest: None


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Clinical experience suggests that acute postoperative pain after radical surgery for breast cancer can be managed by bupivacaine irrigation. This prospective randomized double blind controlled study was designed to test the hypothesis that bupivacaine irrigation will reduce the 24 hour requirement of tramadol (400 mg + 100 mg) by one fourth (100+25mg). Forty six patients were allocated randomly to receive intravenous tramadol (Group T) (0.25mg.kg -1 .hr -1 ) and bupivacaine drain irrigation(Group B) (0.4% 20 ml 8 hourly) for postoperative pain. Pain was monitored independently by the APS and PACU nursing staff. APS residents were allowed to give intravenous boluses of tramadol of 50 mg on complaints of pain. Pain scores, nausea, vomiting, sedation, urinary retention ECG and haemodynamic changes were monitored for 24 hours and analysed by Mann-Whitney u test and Fisher's exact test. Both groups had good pain relief. The T group had significantly more nausea (P<0.007). The T group patients had a higher incidence of vomiting, catheterisation and delayed oral intake, but this was not significant statistically. Bupivacaine administered through the surgical drain offered equivalent postoperative pain relief to intravenous tramadol, with significantly less nausea.


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