Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section

Olayinka Olumide Ajiboye; Adeyemi William Osebequin; Agu Edith; Olateju Simeon Olugbade; Achi Joseph; Oyewole Ezekiel

doi:doi:10.11648/j.ijacm.20241201.11

Research Article |

| Peer-Reviewed

Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section

Olayinka Olumide Ajiboye, Adeyemi William Osebequin, Agu Edith, Olateju Simeon Olugbade, Achi Joseph, Oyewole Ezekiel

Published in International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 1)

Received: 16 December 2023 Accepted: 2 January 2024 Published: 18 January 2024

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 1)
DOI	10.11648/j.ijacm.20241201.11
Page(s)	1-6
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Wound Infiltration, Bupivacaine, Ketamine, Tramadol, Caesarean Section

References

[1]	Ogboli-Nwasor E, Sule T, Yusufu L. Pattern of postoperative pain management among adult surgical patients in a low-resource setting. J Pain Res 2012; 5: 117–200.
[2]	Kolawole K, Fawole A. Postoperative pain management following caesarean section in University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. West Afr J Med 2003; 22: 305–309. Jul. 21, 2018.
[3]	Kintu A, Abdulla S, Lubikire A, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Services Research 2019; 19: 68.
[4]	Cartlin S, Brendan C. Optimal pain management after Cesarean delivery. Anesthesiol Clin. 2017: 35; 107 – 124.
[5]	Narendra PL, Hedge HV, Chandrashekharappa K, et al. Survey of surgeons Attitude to local Anesthetics for postoperative pain relief. Anesth Essays Res. 2019, 13(3) 452-464.
[6]	Miller R. Pardo M, editors. Basics of Anesthesia. 6th ed, Philadelphia, Elsevier Saunders (USA): 2011. Chapter 17 Spinal and Epidural Anesthesia. p. 251-281.
[7]	Olivia BM, Nilo CL, Alberto PP, et al. Comparison of the effects of local infiltration of tramadol on the post-operative pain and incidence of its side effects among adult patients following elective surgery in 2013: a multi-center experience. jamcollsurg. 2014.07.628.
[8]	Gao M, Rajeei D, Liu H. Ketamine use in current clinical practice. Acta Pharmacol Sin 2016: 37(7): 865–872.
[9]	Mohammadreza S, Azim H, Zahra N. Pre-incisional Analgesia with intravenous or subcutaneous infiltration of ketamine reduces postoperative pain in patients after open cholecystectomy: A Randomized Double-Blind Placebo-Controlled study. PainMedicine 2011, 12: 1418–1426.
[10]	Chow C, Shao J, and Wang H, Sample size calculation in clinical research. New York: Marcel Dekker, 2003: 9.
[11]	Muzlifah K. B, Chow Y. C, Comparison between preloading with 10ml/kg and 20ml/kg of ringers lactate in preventing hypotension during spinal anaesthesia for caesarean section. Med J Malaysia 2009; 64: 114-117.
[12]	Warnicke T, Jorum E, Stubhaug A. Local treatment with the N-methyl-D-aspartate receptor antagonist ketamine, inhibit development of secondary hyperalgesia in man by peripheral action. Neurosci Lett 1997: 227: 1-4.
[13]	Behaeen K, Soltanzadeh M, Nesioonpour S, et al. Analgesic Effect of Low Dose Subcutaneous Ketamine Administration Before and After Cesarean Section. Iran Red Crescent Med J 2014; 16: e15506.
[14]	Edomwonyi N P, Osazuwa M O, Iribhogbe O I, Esangbedo S E. Postoperative analgesia using bupivacaine wound infiltration with intravenous tramadol or dexamethasone following obstetric spinal anaesthesia. Niger J Clin 2017; 20: 1584-1589.
[15]	Mohammad A. Simin A, Ehasan M. Local infiltration of tramadol versus bupivacaine for post caesarean section pain control: A double blind randomized study. Iran J Med Sci. 2017; 42: 235-241.
[16]	Sachidananda R, Joshi V, Shaikh I, Umesh G, Mrudula T, Marutheesh M. Comparison of analgesic efficacy of wound infiltration with bupivacaine versus mixture of bupivacaine and tramadol for postoperative pain relief in caesarean section under spinal anaesthesia: A double-blind randomized trial. J Obstet Anaesth Crit Care 2017; 7: 85-89.
[17]	Abdallah NM, Salama AK, Ellithy AM. Effects of preincisional analgesia with surgical site infiltration of ketamine or levobupivacaine in patients undergoing abdominal hysterectomy under general anaesthesia; a randomized double blind. Saudi J Anaesth 2017; 11: 267-272.
[18]	Abdullah MK and Waleed AM. Post herniorrhaphy infiltration of tramadol versus bupivacaine for postoperative pain relief: a randomized study. Ann Saudi Med. 2008 May-Jun; 28(3): 165-168.
[19]	Butterworth J, Mackey D, Wasnick J, editors. Morgan and Mikhail’s Clinical Anesthesiology 5th ed, McGraw Hill Education/Medical New York (USA): 2013. Chapter 45, Spinal, Epidural, and Caudal Blocks; p. 937- 973.
[20]	Bupivacaine medical facts from Drugs. com [Internet]. [cited 2018 Jul 22]; Available from: https://www.drugs.com/mtm/bupivacaine.html
[21]	Ketamine Injection - FDA prescribing information, side effects and uses [Internet]. [cited 2018 Jul. 21]; Available from: https://www.drugs.com/pro/ketamine-injection.html
[22]	Abigail Whiteman, Sanjay Bajaj, Maan Hasan. Novel techniques of local anaesthetic infiltration. Continuing education in anaesthesia Critical care & pain 2011; 11: 167-171.
[23]	Jabalameli M, Safavi M, Honarmand A, et al. The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res 2012; 1: 53, 10.4103/2277-9175.100165.

Cite This Article

Plain Text BibTeX RIS

APA Style

Ajiboye, O. O., Osebequin, A. W., Edith, A., Olugbade, O. S., Joseph, A., et al. (2024). Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. International Journal of Anesthesia and Clinical Medicine, 12(1), 1-6. https://doi.org/10.11648/j.ijacm.20241201.11

Copy | Download

ACS Style

Ajiboye, O. O.; Osebequin, A. W.; Edith, A.; Olugbade, O. S.; Joseph, A., et al. Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. Int. J. Anesth. Clin. Med. 2024, 12(1), 1-6. doi: 10.11648/j.ijacm.20241201.11

Copy | Download

AMA Style

Ajiboye OO, Osebequin AW, Edith A, Olugbade OS, Joseph A, et al. Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. Int J Anesth Clin Med. 2024;12(1):1-6. doi: 10.11648/j.ijacm.20241201.11

Copy | Download

@article{10.11648/j.ijacm.20241201.11,
  author = {Olayinka Olumide Ajiboye and Adeyemi William Osebequin and Agu Edith and Olateju Simeon Olugbade and Achi Joseph and Oyewole Ezekiel},
  title = {Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {12},
  number = {1},
  pages = {1-6},
  doi = {10.11648/j.ijacm.20241201.11},
  url = {https://doi.org/10.11648/j.ijacm.20241201.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241201.11},
  abstract = {Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section
AU  - Olayinka Olumide Ajiboye
AU  - Adeyemi William Osebequin
AU  - Agu Edith
AU  - Olateju Simeon Olugbade
AU  - Achi Joseph
AU  - Oyewole Ezekiel
Y1  - 2024/01/18
PY  - 2024
N1  - https://doi.org/10.11648/j.ijacm.20241201.11
DO  - 10.11648/j.ijacm.20241201.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 1
EP  - 6
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20241201.11
AB  - Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.

VL  - 12
IS  - 1
ER  -

Copy | Download

Author Information

Olayinka Olumide Ajiboye

Department of Anaesthesia, Garki Hospital Abuja, Abuja, Nigeria

Contact Email
Adeyemi William Osebequin

Department of Anaesthesia, Federal Teaching Hospital, Lokoja, Nigeria
Agu Edith

Department of Anaesthesia, Federal Teaching Hospital, Lokoja, Nigeria
Olateju Simeon Olugbade

Department of Anaesthesia and Intensive Care, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
Achi Joseph

Department of Anaesthesia, University of Nigeria Teaching Hospital, Enugu, Nigeria
Oyewole Ezekiel

Department of Anaesthesia, Federal Teaching Hospital, Lokoja, Nigeria

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Ajiboye, O. O., Osebequin, A. W., Edith, A., Olugbade, O. S., Joseph, A., et al. (2024). Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. International Journal of Anesthesia and Clinical Medicine, 12(1), 1-6. https://doi.org/10.11648/j.ijacm.20241201.11

Copy | Download

ACS Style

Ajiboye, O. O.; Osebequin, A. W.; Edith, A.; Olugbade, O. S.; Joseph, A., et al. Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. Int. J. Anesth. Clin. Med. 2024, 12(1), 1-6. doi: 10.11648/j.ijacm.20241201.11

Copy | Download

AMA Style

Ajiboye OO, Osebequin AW, Edith A, Olugbade OS, Joseph A, et al. Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section. Int J Anesth Clin Med. 2024;12(1):1-6. doi: 10.11648/j.ijacm.20241201.11

Copy | Download

@article{10.11648/j.ijacm.20241201.11,
  author = {Olayinka Olumide Ajiboye and Adeyemi William Osebequin and Agu Edith and Olateju Simeon Olugbade and Achi Joseph and Oyewole Ezekiel},
  title = {Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {12},
  number = {1},
  pages = {1-6},
  doi = {10.11648/j.ijacm.20241201.11},
  url = {https://doi.org/10.11648/j.ijacm.20241201.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241201.11},
  abstract = {Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - Analgesic and Opioid Sparing Effects of Tramadol, Ketamine, and Bupivacaine Following Wound Infiltration After Caesarean Section
AU  - Olayinka Olumide Ajiboye
AU  - Adeyemi William Osebequin
AU  - Agu Edith
AU  - Olateju Simeon Olugbade
AU  - Achi Joseph
AU  - Oyewole Ezekiel
Y1  - 2024/01/18
PY  - 2024
N1  - https://doi.org/10.11648/j.ijacm.20241201.11
DO  - 10.11648/j.ijacm.20241201.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 1
EP  - 6
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20241201.11
AB  - Background: Adequate management of pain is considered a fundamental human right and social justice and this may be achieved for women who had caesarean section under subarachnoid block with multi modal means of analgesia. Wound infiltration with different agents may be part of the multi modal means of providing adequate analgesia. The study aimed to determine which of plain bupivacaine, ketamine or tramadol will give the best pain control post-operatively in terms of quality and duration of pain relief when used for wound infiltration following caesarean section under subarachnoid block. Methods: A prospective double blind randomized study of 132 patients, divided into three groups of A, B, and C with 44 patients in each group. Each group had wound infiltration with either 0.125% plain bupivacaine (Group A), 0.25% ketamine (Group B), or 0.25% tramadol (Group C) after caesarean section under subarachnoid block. Pain was assessed hourly in the first 4 hours then 4 hourly for 20hours. The duration of pain relief after subcutaneous infiltration, morphine consumption, and side effects were noted for all the three groups. Results: Time to first rescue analgesic was similar in all three groups, however duration of analgesia was longest in Group A (4 hours). ANOVA analysis of the time to first analgesic request across the three groups was not statistically significant (p=0.0862). Morphine consumption was highest in Group C with an average of 7mg in 24 hours, but was lower in Groups A and B which were 5.09mg and 5.63mg respectively in 24 hours. Using the 5 point Likert to test for patient satisfaction; group A recorded highest percentage of patients who strongly agreed to being satisfied, while the least percentage to satisfaction was found in Group C. Conclusion: This study demonstrated that of the three drugs tested, bupivacaine was the most effective analgesic with consequent reduction in opioid consumption and offered prolonged patient satisfaction.

VL  - 12
IS  - 1
ER  -

Copy | Download