Epidural tramadol for postoperative pain after Cesarean section

Purpose: To compare the post-operative analgesic effect of 100 mg vs 200 mg epidural tramadol and saline in patients undergoing elective Cesarean section. Methods: Sixty healthy women undergoing Cesarean delivery with epidural anesthesia were randomly allocated into three groups (n = 20 in each). Patients received, at skin closure via the epidural catheter, 100 mg tramadol (Group 1), 200 mg tramadol (Group II) or 10 ml saline (Control group). Pain scores and side effects were evaluated at 1, 2, 4, 8, 12 and 24 hr after surgery. Mean times to the first analgesic administration, as well as the cumulative doses of analgesic requirements over 24 hr postoperatively were compared. Results: The mean time to first analgesic administration was longer in patients who received 100 mg tramadol (4.5 +/- 3.1 hr) and the 200 mg tramadol (6.6 +/- 3.4 hr) than in those who received placebo (2.8 +/- 2 hr). The mean cumulative doses of meperidine over 24 hr were less in the 100 mg tramadol group (0.3 +/- 0.3 mg.kg(-1)) and the 200 mg tramadol group (0.3 +/- 0.3 mg.kg(-1)) than In the control group (0.7 +/- 0.4 mg.kg(-1)). Also, the mean doses of diclofenac over 24 hr were less in the 100 mg tramadol group (156 +/- 59 mg) and the 200 mg tramadol group (142 +/- 62 mg) than in the control group (214 +/- 70 mg), However, no difference was obtained between patients receiving 100 mg and 200 mg tramadol concerning all parameters studied. Conclusion: Epidural tramadol 100 mg can provide adequate postoperative analgesia without respiratory depression in patients after Cesarean delivery.