Master of Clinical Anesthesia

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Browsing Master of Clinical Anesthesia by Author "DULA ABABA"

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    COMPARISON OF POSTOPERATIVE ANALGESIA EFFECTIVENESS OF SPINAL BUPIVACAINE ALONE AND IN COMBINATION WITH TRAMADOL AND FENTANYL DURING CESAREAN DELIVERY AT ARSI UNIVERSITY TEACHING AND REFERRAL HOSPITAL. PROSPECTIVE COHORT STUDY
    (2025-05-01) DULA ABABA
    ABSTRACT Background: Cesarean section is a common obstetric procedure that is usually performed under spinal anesthesia with bupivacaine being the most commonly used local anesthetics. Adjuvants added to bupivacaine during the single shot spinal anesthesia helps in extending postoperative analgesia duration and minimize side effects. Existing studies on intrathecal tramadol and fentanyl reported conflicting results on the postoperative analgesia duration; some reported fentanyl is effective while other may support tramadol. Objective: To compare the postoperative analgesia effectiveness of spinal bupivacaine alone with that of bupivacaine combined with adjuvants tramadol and fentanyl for elective cesarean section at Arsi University Referral and Teaching Hospital from July to September, 2025. Methods: An institutional-based prospective cohort was conducted on 93 parturients. Systematic sampling technique was employed. Data was collected with chart review, intraoperative observation and postoperatively patient interview. Shapiro wilk test was used to assess normality of the data. For normally distributed, analysis of variance (ANOVA) while Kruskal Wallis test was applied for not normally distributed data. Time to event variable was analyzed by using Kaplan Meir’s survival function. P value less than 0.05 with a power 90% was considered statistically significant Results: A total of 93 parturients (31 in each group) were included in the final analysis. The duration of postoperative analgesia was significantly longer in the bupivacaine tramadol group to (420.63 ± 14.43 minutes) compared to the bupivacaine fentanyl group (283.83 ± 19.28 minutes) and the bupivacaine alone (154.07 ± 24.63 minutes), P < 0.0001. Total postoperative Analgesia consumption was significantly lower in the bupivacaine tramadol group, (p < 0.0001). The total obstetric quality of recovery score was highest in the bupivacaine tramadol group 72 (66 -81), followed by bupivacaine fentanyl group 69.5 (54 – 79) and bupivacaine alone 60 (45 -71), P < 0.0001. Conclusion: Addition of preservative free Tramadol to bupivacaine as adjuvants in spinal anesthesia for elective cesarean section increased analgesia duration, decreased 24-hour analgesia consumption, prolong time to first analgesia requests and improved obstetric quality of recovery. Key Words: Spinal anesthesia, Postoperative pain, Tramadol, Fentanyl