Effect of tramadol as a local anesthetic adjuvant in epidural labor analgesia: Randomized controlled study

Background: Epidural analgesia has been established to be the best modality for painless labor. This study hypothesized to evaluate the effect of adding tramadol as an adjuvant to bupivacaine in epidural labor analgesia. Methods: Sixty parturients were allocated into two equal groups. Group B received a total volume of 10 ml bupivacaine 0.25% in normal saline. Group BT received a total volume of 10 ml bupivacaine 0.25% plus tramadol 5 mg/ml in normal saline as a loading dose, followed by continuous infusion of bupivacaine 0.125% at rate 10 ml/h 15 min after a loading dose for both groups. The onset of analgesia, degree of motor block, sedative effect, hemodynamic parameters, visual analogue scale (VAS), number of top-up doses, fetal outcomes, any related side effects, and maternal satisfaction were recorded. Results: Faster onset of analgesia was achieved in BT group compared to B group (7.9 +/- 2.68 vs 15.3 +/- 3.3, respectively: P < 0.001). BT group has a longer duration of analgesia (181.1 +/- 44.3 min) than B group (89.6 +/- 32.6 min) (P < 0.001). VAS was significantly decreased at 10, 15, 60, 120 and 180 min in BT group compared to B group (P < 0.001, < 0.001, 0.001, < 0.001, and 0.006, respectively). Motor block was comparable between both groups. Higher levels of sedation were reached in group BT. Conclusion: Tramadol in epidural labor analgesia as an adjuvant to bupivacaine can provide a better quality of analgesia with faster onset, and prolonged duration with no relevant adverse effects