Effect of Intramuscular Tramadol on the Duration of Clinically Relevant Sciatic Nerve Blockade in Patients Undergoing Calcaneal Fracture Fixation: A Randomized Controlled Trial.

Autor:	Janiak M; 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland., Gorniewski G; Department of Anesthesiology and Intensive Care Education, Medical University of Warsaw, 02-007 Warsaw, Poland., Kowalczyk R; 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland., Wasilewski P; Department of Orthopedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland., Nowakowski P; Department of Anesthesiology and Intensive Care, Gruca Orthopedic and Trauma Teaching Hospital, 05-400 Otwock, Poland., Trzebicki J; 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland.
Jazyk:	angličtina
Zdroj:	Healthcare (Basel, Switzerland) [Healthcare (Basel)] 2023 Feb 08; Vol. 11 (4). Date of Electronic Publication: 2023 Feb 08.
DOI:	10.3390/healthcare11040498
Abstrakt:	Background: Calcaneal fracture fixation can generate severe postoperative pain and analgesia can be supported by a sciatic nerve block. However, following resolution of the sensory blockade, rebound pain may ensue. The aim of this study was to assess whether an incidental finding of two patients with an extension of the sciatic nerve block beyond 24 h following 100 mg of intramuscular tramadol administration could be confirmed. Methods: Thirty-seven patients scheduled for a calcaneal intramedullary fixation (Calcanail ® ) were randomly divided into two groups. The tramadol group ( n = 19) received a sciatic nerve block with 20 mL of 0.25% bupivacaine and a concomitant dose of 100 mg of intramuscular tramadol, while the control group ( n = 18) received an identical sciatic nerve block with concomitant injection of normal saline (placebo). All patients had a spinal anesthesia with light sedation for the procedure. The time to first analgesic request defined as appearance of any pain (NRS > 0) was assessed as the primary endpoint with a clinically relevant expected result of at least 50% elongation in sensory blockade. Results: The median time to first analgesic request from time of blockade in the tramadol group was 670 min compared with 578 min in the control group. The result was clinically not relevant and statistically not significant ( p = 0.17). No statistical difference could be demonstrated in the time to first opioid request, although a trend for opioid sparing in the tramadol group could be seen. Total morphine consumption in the first 24 h was also statistically insignificant (the tramadol group 0.066 mg kg -1 compared with 0.125 mg kg -1 in the control group). In conclusion, intramuscular tramadol does not extend the duration of analgesia of a sciatic nerve block following a calcaneal fracture fixation beyond 2 h and an opioid sparing effect could not be demonstrated in this trial.
Databáze:	MEDLINE
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