Postoperative Pain Management Following Transurethral Resection of the Prostate: A Comparative Study between Epidural Bupivacaine, Tramadol and Their Combination

Abstract

Epidural analgesia using different local anesthetic-opioid combinations is a widely used technique for postoperative pain relief after major abdominal and pelvic operations. However, potentially serious adverse effects of epidural opioids as respiratory depression may create some boundaries to their liberal use. Attempts to overcome these problems have lead to the search for newer opioids with fewer side effects.

Tramadol is a synthetic analogue of codeine with moderate affinity at the µ-opioid receptors. In addition it has non-opioid mechanisms of analgesia by inhibition of noradrenaline reuptake and stimulation of serotonin release. These complementary mechanisms result in an opioid with potent analgesia but with a striking lack of respiratory depressant effect.