The Analgesic Efficacy and Safety of the Association Tramadol - Bupivacaïne Versus Morphine- Bupivacaïne In Epidural Thoracic Analgesia For Thoracotomy

Background: The aim of this study is to compare the analgesia efficacy and side effects in patients undergoing an elective thoracotomy with thoracic epidural analgesia using tramadol or morphine in association with bupivacaine. Patients and Methods: It is a prospective, randomized, double blind study, 40 patients scheduled for thoracotomy randomized after anesthesia induction in two equal groups. Each patient received in epidural analgesia using bupivacaine with morphine (Group 1) or bupivacaine with tramadol (Group 2). In post-operative evaluation, pain was measured using a visual analog scale (VAS), arterial blood gas, post-operative sedation and other side effects was done throughout 48 hours. Results: All the groups were homogeneous with respect to their demographics. The total consumption of bupivacaïne, the number of boluses and analgesia scores at rest, during coughing and during respiratory physiotherapy were comparative in both groups. Patients in tramadol group were less sedated within the first 4 hours (p: 0.02) and had less respiratory depression within the first 6 post-operative hours (p: 0.007). Nausea, vomiting, pruritus and urinary retention were comparative in both groups. Conclusion: Our study showed that after thoracotomy, the post-operative analgesia provided by tramadol associated with bupivacaïne by epidural thoracic catheter was similar to that with morphine. The risks of sedation and respiratory depression were less for the patients receiving tramadol than morphine.