Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: A systematic review and meta-analysis

Shin, Hye Won; Ju, Bum Jun; Jang, Yoo Kyung; You, Hae Seun; Kang, Hyun; Park, Ji Yong

doi:10.1371/journal.pone.0184649

Cited by 23 publications

(26 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two systematic reviews also ended up with different conclusions and recommendations [8,9]. The first, based on eight studies, suggested that patients undergoing surgery under brachial plexus block will not benefit from tramadol added as adjuvant as there is lack of effectiveness to prolong analgesia; additionally, the potential of neurotoxicity of tramadol when injected perineurally cannot be excluded [8].…”

Section: Discussionmentioning

confidence: 99%

“…The first, based on eight studies, suggested that patients undergoing surgery under brachial plexus block will not benefit from tramadol added as adjuvant as there is lack of effectiveness to prolong analgesia; additionally, the potential of neurotoxicity of tramadol when injected perineurally cannot be excluded [8]. In contrast, the second review and meta-analysis that included 16 randomized control studies and 751 patients showed that 100 mg but not 50 mg tramadol as adjuvant prolonged the duration of the sensory and motor blocks, and eventually prolonged postoperative analgesia with no impact on adverse effects [9]. The onset of sensory and motor blocks was also enhanced [9].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies, including two systematic reviews [8,9], have concluded with contradictory results and recommendations regarding the addition of tramadol to the local anesthetic solution injected for brachial plexus block of different regional anesthesia approaches. To confirm or negate these conflicting reports, we performed this prospective randomized study to evaluate the effectiveness of tramadol as adjuvant to ropivacaine for interscalene brachial plexus block on the opioid consumption and early postoperative pain in patients who underwent shoulder surgery.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Addition of 100 mg of Tramadol to 40 mL of 0.5% Ropivacaine for Interscalene Brachial Plexus Block Improves Postoperative Analgesia in Patients Undergoing Shoulder Surgeries as Compared to Ropivacaine Alone—A Randomized Controlled Study

et al. 2019

View full text Add to dashboard Cite

Background and objectives: Brachial plexus block is commonly used in shoulder surgery, as it provides satisfactory surgical conditions and adequate postoperative pain control. However, there are contradictory reports regarding the addition of tramadol to the injected regional anesthetic solution. We performed a prospective randomized study to evaluate the effectiveness of tramadol as an adjuvant to ropivacaine during interscalene brachial plexus block and assess its impact on the opioid consumption and the early postoperative pain in patients that underwent shoulder surgery. Materials and Methods: Eighty patients scheduled for elective shoulder surgery and anesthesia via interscalene brachial plexus block were randomly divided into two groups. In group A (n = 40), a solution of 40 mL of ropivacaine 0.5% and 2 mL (100 mg) of tramadol was administered during the brachial plexus block, while in group B (n = 40), a solution of 40 mL of ropivacaine 0.5% and 2 mL NaCl 0.9% (placebo) was administered. The effectiveness and duration of sensory and motor blocks were recorded in both groups. The sensory block was assessed recording the loss of sensation to pin prick test over the skin distribution of the axillary, radial, and musculocutaneous nerves. The motor block was assessed using the modified 3-point Bromage score (0–2 points). Cumulative morphine consumption and pain, using the Visual Analog Scale (VAS), were evaluated in both groups at 2, 4, 8, and 24 h after surgery. Results: Sensory block onset was achieved earlier in group A than in group B (5.21 ± 3.15 minutes (min) vs. 7.1 ± 4.51 min, p = 0.029). The motor block onset was similar between the two groups (13.08 ± 6.23 min vs. 13.28 ± 6.59 min; p = 0.932). The duration of the sensory block was longer in group A as compared to group B (13 ± 2.3 h vs. 12 ± 2.8 h; p = 0.013). The duration of the motor block did not present any difference between the groups (10 ± 2.2 h vs. 10 ± 2.8 h; p = 0.308). Differences in morphine administration were not significant at 2, 4, and 8 h, however, morphine consumption was found to be decreased in group A 24 h postoperatively A (p = 0.04). The values of VAS were similar at 2, 4, and 8 h, however, they were lower in group A at 24 h (p < 0.013). Conclusions: Combined regional administration of tramadol and ropivacaine during interscalene brachial plexus block improves the time of onset and the duration of the sensory block, while it is associated with reduced morphine consumption during the first 24 h after shoulder surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Addition of 100 mg of Tramadol to 40 mL of 0.5% Ropivacaine for Interscalene Brachial Plexus Block Improves Postoperative Analgesia in Patients Undergoing Shoulder Surgeries as Compared to Ropivacaine Alone—A Randomized Controlled Study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Brachial plexus block (BPB) is now a widely used technique adopted by anesthesiologist for surgeries involving the upper limb and for acute pain management. 2 BPB is advantageous when compared with general anesthesia, because it provides better pain control, no side effects as with general anesthesia and llonger control of post-op pain. 3 However, the duration of block is only 8 hours to 14 hours even with the use of longer half-life local anesthetics.…”

Section: Introductionmentioning

confidence: 99%

“…4 Many adjuvants have been searched to extend the analgesic efficacy and to reduce adverse outcomes of local anesthesia such as perineural magnesium, dexmedetomidine, clonidine, dexamethasone and tramadol. 2,[5][6][7][8] Use of tramadol as oral or parenteral is now proven effective for post-op management of pain. 9 Tramadol minimizes pain using two different pathways; opioid like action mediated by action of μ receptors and 2 nd one mediated by its α 2 -adrenergic and serotoninergic activity.…”

Section: Introductionmentioning

confidence: 99%

Tramadol as an adjunct to bupivacaine for brachial plexus block.

Zahoor¹,

Mussrat²,

Khan³

et al. 2019

TPMJ

View full text Add to dashboard Cite

ABSTRACT… Objectives: To compare the efficacy of tramadol and 0.25% bupivacaine versus 0.25% bupivacaine alone for brachial plexus block. Study Design: Randomized controlled study. Setting: Orthopedic department of Nishtar Medical University/Hospital Multan. Period:The study duration was Jan-2018 to Aug-2018. Material and Methods: 148 patients planned for with upper limb orthopedic procedures under BPB in the department of orthopedics department Nishtar Hospital Multan were included in this analysis. To Patients were randomly divided into two equal groups by lottery method. Group A patients were given solution with 38 ml 0.25% bupivacaine with 100 mg tramadol 2 ml and group B were given solution with 38 ml 0.25% bupivacaine and 2 ml 0.9 % normal saline. Time of onset of block and its duration and need for rescue analgesics were noted. Results: Time of onset of block was 14.56+1.01 minutes in group A versus 15.96+1.64 minutes in group B (p-value <0.001). Mean analgesia duration was 355.85+42.18 minutes in group A versus 310.47+38.79 minutes in group B (p-value <0.001). There were 51 (68.9%) patients in group A who required rescue analgesia and 68 (91.9%) patients in group B required rescue analgesia (p-value 0.004). Conclusion: We concluded that the addition of tramadol as adjunct to bupivacaine for BPB significantly shortens the duration of onset, prolongs the duration of analgesia and reduces the need for rescue analgesics.

show abstract

Superior Laryngeal Nerve Block Response Rates in 54 Neurogenic Cough Patients

et al. 2023

View full text Add to dashboard Cite

ObjectiveNeurogenic cough related to hypersensitivity of the internal branch of the superior laryngeal nerve (SLN) is often treated with neuromodulating medications, which can cause considerable side effects. An alternative therapy is steroid and local anesthetic injection of the SLN (“SLN block”), initially proposed to benefit those with lateralizing symptoms (tenderness over the thyrohyoid membrane or unilateral cough source). Our objectives are to determine if SLN block produces subjective symptomatic improvements and if repeat injections further improve symptoms, and evaluate clinical factors potentially predictive of response.MethodsRetrospective chart review of 54 patients receiving SLN blocks at a tertiary medical academic center from January 2010 to June 2020. Medical history and anticipated predictors of positive response, including stigmata of laryngeal hypersensitivity, were recorded. Outcomes included symptomatic response, number of injections required, and side effects. Response was defined subjectively by asking patients whether the injection was beneficial and objectively by using CSI scores.ResultsFifty‐four patients met the inclusion criteria. Thirty‐eight patients (70.4%) endorsed improvement. No variables were identified as positive predictors of response. Thirty‐two of the 38 (84.2%) endorsed improvement after one injection. Six of 15 (40%) patients who failed the first injection had positive response to the second. No significant side effects were reported.ConclusionNo localizing symptoms, specific cough features, or aspects of the medical history helped predict response, suggesting that a broader range of patients may be offered the intervention. The majority of patients reported symptomatic improvement and repeat injections may benefit patients with initial nonresponse.Level of Evidence4 Laryngoscope, 133:2647–2653, 2023

show abstract

Effect of tramadol as an adjuvant to local anesthetics for brachial plexus block: A systematic review and meta-analysis

Cited by 23 publications

References 34 publications

Addition of 100 mg of Tramadol to 40 mL of 0.5% Ropivacaine for Interscalene Brachial Plexus Block Improves Postoperative Analgesia in Patients Undergoing Shoulder Surgeries as Compared to Ropivacaine Alone—A Randomized Controlled Study

Addition of 100 mg of Tramadol to 40 mL of 0.5% Ropivacaine for Interscalene Brachial Plexus Block Improves Postoperative Analgesia in Patients Undergoing Shoulder Surgeries as Compared to Ropivacaine Alone—A Randomized Controlled Study

Tramadol as an adjunct to bupivacaine for brachial plexus block.

Superior Laryngeal Nerve Block Response Rates in 54 Neurogenic Cough Patients

Contact Info

Product

Resources

About