Razi Journal of Medical Sciences

    Background & Aim: Epidural anesthesia is one of the anesthethic techniques for cesarean section. However, epidural anesthesia with lidocaine has some disadvantages such as delayed onset of action and short duration of analgesia. The goal of this study is to evaluate maternal sensory and motor blockade, neonatal Apgar score, and side effects of adding 50 and 100 mg tramadol to 2% lidocaine in epidural anesthesia for elective cesarean section. Patients & Method: Ninety 20 to 40-year-old pregnant patients with ASA physical status I or II who were candidates for elective cesarean section under epidural anesthesia were included in this prospective and randomized study. Epidural anesthesia was performed in lateral position by means of a 18-gauge epidural needle, through L3-4 space. Epidural catheter for additional injections was indwelt. The patients were randomly divided into three groups including 30 each. Anesthetic solution in the control group(lidocaine group: L) contained 20ml 2% lidocaine with epinephrine(1:200,000), in the LT50 group 50mg tramadol, and in the LT100 group 100mg tramadol was added to the above-mentioned epidural solution. For additional intraoperative analgesia, at first 5ml 2% lidocaine through epidural catheter and then 5µg intravenous sufentanil were administered. Postoperative analgesia was provided by 100mg intramuscular meperidine. The onset of sensory block at T6, the highest level of sensory block, the onset of regression in two dermatomes, the onset and duration of complete motor block, sedation score, total intraoperative drug consumption(lidocaine and sufentanil), neonatal Apgar score, the duration of postoperative analgesia, the time of the first request for postoperative analgesics, total 12-hour consumption of postoperative analgesics, complications, and demographic data were recorded. Results: There were no significant differences among the three groups in demographic data and the duration of anesthesia and surgery. Although in the LT100 group the onset of complete motor and sensory block at T6 was more rapid than two other groups, the highest level of sensory block(above T6), the onset of regression in two segments, and the duration of complete motor block were not different between LT50 and LT100 groups but were higher and more prolonged than L group. Also, the average intraoperative lidocaine and sufentanil consumption in LT50 and LT100 groups showed no difference but was lower than L group. The three groups showed no statistically significant difference in the incidence of maternal complications and neonatal Apgar score. In LT50 and LT100 groups, the time of the first postoperative requirement of analgesics was statistically prolonged and the average meperidine consumption was lower than L group. Conclusion: The present study indicates that adding tramadol to 2% lidocaine in pregnant patients undergoing epidural anesthesia for cesarean section offers advantages over using lidocaine alone in terms of intraoperative anesthesia and postoperative analgesia. Moreover, this addition does not increase maternal and neonatal complications.