The Effects of Tramadol and Levobupivacaine Infiltration on Postoperative Analgesia in Functional Endoscopic Sinus Surgery and Septorhinoplasty

Abstract

Objective: The aim of this prospective, randomized, double-blind study was to investigate the postoperative analgesic effects of levobupivacaine or tramadol infiltration administered prior to surgery in septorhinoplasty (SRP) or endoscopic sinus surgery (ESS).Material and Methods: Sixty ASA class I-III adult patients electively undergoing SRP or ESC were included the study. Induction of anesthesia was performed with propofol 2-2.5 mg/kg, rocuronium bromide 0.6 mg/kg and fentanyl 1 μg/kg i.v. Sevoflurane 2% with an N 2 O/O 2 mixture (FiO 2 : 35%) was used for maintenance. Tramadol 0.5 mg/kg (Group T: n=20), levobupivacaine 0.25% (Group L: n=20) and lidocaine 1% (Group C: n=20) in a 1/200,000 adrenaline solution was infiltrated into the surgical area 10 min before the operation (5 mL for ESS and 10 mL for SRP). All patients received fentanyl (bolus dose: 15 μg and lockout interval: 10 min) with a patient-controlled analgesia device during the postoperative period. Pain was assessed using an 11-point visual analogue scale (VAS) every 4 h for the first 24 h. Analgesic requirements, opioid consumption and side effects in the postoperative period were recorded.Results: There was a statistically significant decrease in postoperative fentanyl demand and consumption in patients receiving tramadol. Fentanyl doses in the 24 h period were 345.2±168.8 μg, 221.1±120.6 μg and 184.1±130.3 μg (p=0.002) for the Groups C, L and T, respectively. There were statistically significant differences in fentanyl requirements between the tramadol and control groups at the 16, 20 and 24 h time points (p=0.012, p=0.004 and p=0.002, respectively). The side effect profiles were similar.Conclusions: Our study indicates that the preemptive tramadol infiltration technique is an efficient, practical and safe alternative to levobupivacaine in ESS or SRP operations.

Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence‐Based Review

“…When compared to opioids, tramadol was reported by Koputan et al to have higher VAS at 16 hours postoperative ( P = .003), PCA requirements at 20 hours ( P = .01), and total rescue analgesic consumption at 16, 20, and 24 hours (345.2 μg vs. 211.1 μg vs. 184.1 μg, P = .012, .004, and .002, respectively). However, levobupivacaine was shown to be possibly as effective as tramadol with significant differences in VAS scores between levobupivacaine and the control at 20 hours postoperatively ( P = .005) . Of the 807 included patients, 35 (4.3%) experienced nausea or vomiting.…”

“…Fourteen articles explored the use of local anesthetics . Of these studies, all 14 were prospective RCTs with four single‐blinded, nine double‐blinded, and one triple‐blinded.…”

“…Supporting Table 3 in the online version of this article presents the accumulated data for these 14 studies. Ten of the studies assessed the efficacy of local anesthetics given prior to incision, whereas four looked at postoperative value. Six studies compared local anesthetics to control groups.…”

“…In addition to regional blockade with agents such as levobupivacaine, six of the included studies involved topical application of local anesthetic or surgical sponges dipped in anesthetic solution. Interestingly, the effect of decreased analgesic requirements was found to extend beyond the length of action of these local agents, up to 24 hours postoperatively in several studies . Topical application of local anesthetics via nasal packing was used in three studies .…”

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

“…No other systematic review or meta‐analysis was found pertaining to perioperative and postoperative analgesic use for endoscopic sinus surgeries. Thirty‐two studies met the inclusion criteria for this project: all of the included studies were randomized, controlled trials (RCTs). Using the Cochrane Bias tool, we judged 4 studies to be at high risk, 21 to be at moderate risk, 6 to be at low risk, and 1 to be at unclear risk of bias.…”