Laparoscopic Cholecystectomy

Comparative Study Between Tramadol And Combination Of

Acetamlnopheffl-Famoticlniiie In Laparoscopic Cholecystectomy

Magdy El Babiy; Atef Zarzour; Ashraf El Zeftawy & Hesham El Sheikh

Department of Anesthesiology, Faculty of Medicine -Tanta University

ABSTRACT

Background: This study evaluates the antacid and analgesic effects of single i.m dose of tramadol given 1hour before induction of general anesthesia for laparoscopic cholecystectomy. Intramuscular tramado lincreases gastric pH and reduces gastric content volume during surgery as effective as famotidine.

Methods : Forty patients ASA class I and II scheduled for laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to receive i.m tramadol 100 mg (Group

The incidence and severity of postoperative nausea were significantly higher in group I whereas there was no significant difference between the two groupsregardingpostoperative vomiting. The number of postoperative drowsy, rousable and asleep patients was significantly higher in group I in all recorded times. The severity of postoperative pain was significantly lower in group I during the first 3h after surgery which necessitated less dosage of i.m nalbuphine as a rescue analgesic.

Conclusion : A single i.m dose of tramadol is an effective pre- treatment to minimize the risk of acid aspiration during laparoscopic cholecystectomy and to improve pain relief for 3 h after

Anesthesia was induced by 2.5 mg/ kg i.v propofol. Tracheal intubation was facilitated by 0.6 mg/kg i.v rocuronium. Neuromuscular block was maintained at 80-90% level by 10 mg i.v rocuronium increments as evaluated using train of four stimulation of the ulnar nerve. Anesthesia maintenance was achieved by sevoflurane and 100% oxygen. The lungs were ventilated using a Datex Ohmeda (ASPIRE 5 U.S.A.) ventilator with a circuit incorporating C02 absorber. A continuous fresh gas flow of 4 L/min, an inspiratory:expiratory ratio of 1:2 and zero end-expiratory pressure were applied. In both groups, respiratory frequency and inspiratory tidal volume were adjusted to provide an end-tidal carbon dioxide tension of -in-45 mm Hg during surgery. Carbon dioxide pneumoperitoneum was introduced and maintained with intra-abdominal insufflation pressure limited to 10-12 mmHg in both groups. During surgery, the infusion rates were adjusted at 10-15 ml/kg/h to maintain values of systolic arterial blood pressure and heart rate within ± 20% of baseline values. After induction of anesthesia al6-French gauge multi-orifice nasogastric tube was inserted and its correct position was confirmed by epigastric auscultation of injected air. Gastric content measurement (volume and pH) was made: 5min after induction of