Multimodal analgesia after upper limb orthopedic surgeries: Patient controlled intravenous low dose tramadol analgesia with or without intravenous acetaminophen – A comparative study

AbstractThis study was designed to evaluate the effects of addition of acetaminophen to a low dose tramadol patient controlled intravenous analgesia after unilateral upper limb orthopedic surgeries under general anesthesia.Methods120 Adult patients ASA I and II undergoing unilateral upper limb orthopedic surgeries under general anesthesia were randomly allocated into two groups: Group TA (n=60): received postoperative iv tramadol PCA boluses of 10mg and iv acetaminophen1g/8h.Group T (n=60): received postoperative iv tramadol PCA boluses of 10mg.Volume of tramadol (mg)consumed ,severity of postoperative pain at rest using VAS, postoperative systolic, diastolic arterial blood pressure and heart rate in 24h, patient satisfaction ,adverse effects (sedation, nausea, vomiting, hypotension, respiratory depression) were recorded.ResultsVolume of tramadol (mg) consumed, severity of postoperative pain at rest using VAS 24h were statistically significantly higher in group T, postoperative systolic , diastolic arterial blood pressure and heart rate, adverse events showed no statistical significant differences between the two groups, patient satisfaction was more in group TA.ConclusionThe addition of acetaminophen to a low dose tramadol iv PCA as a multimodal analgesic approach provided satisfactory pain control than tramadol iv PCA alone after unilateral upper limb orthopedic surgeries under general anesthesia