A Study on Epidural Tramadol Compared with Epidural Fentanyl Combined with Low Dose Bupivacaine for the Control of Metastatic Cancer Pain
Background: Despite advances in the knowledge of pathophysiology of pain and its management, patients continue to suffer from pain in many terminal stage cancer. Tramadol hydrochloride is a weak opioid with analgesic properties, and can be tried for cancer pain management.
Objectives: This study was performed to find out the efficacy of the analgesic property of Tramadol through epidural route in cancer patients as an combination with low dose(.125%) Bupivacaine and to compare with Fentanyl, a μ opioid agonist.
Methods: 50 Cancer patients with or without previous pain management were randomly allocated to one of the two study regime- Group-A (tramadol 50 mg) and Group-B (Fentanyl 50 mgm) in combination with .125% Bupivacaine. Drugs were administered epidurally 6 hourly, 8 hourly and 12 hourly respectively for the 1st, 2nd and 3rd day. Low dose bupivacaine was added to both groups to enhance quality. Pain scores, blood pressure, respiratory rate, heart rate, side effects and patients' satisfaction score was recorded 6 hourly for 72 hrs. The data yielded from this study were compiled and analyzed by unpaired and paired ‘t' test with 95% confidence limit. A value of P< 0.05 was considered to be significant. ÷ square test was done for some of the data.
Results: Pain scores were significantly decreased in both the groups but were not significantly different. The incidence of side effects including nausea and vomiting was found in both the groups and was not significantly different between the two groups.
Conclusion: The use of epidural Tramadol in selected cancer pain patients (especially pain in lower abdomen and lower back) may be very useful and is comparable to opioid in certain situations.
Key words: Metastatic cancer pain; Epidural tramadol.
BSMMU J 2009; 2(2): 66-72