Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine+fentanyl combination.

PURPOSE: The aim of this study was to compare the effects of IV tramadol, IV fentanyl, epidural tramadol, and an epidural ropivacaine+fentanyl combination in patient-controlled analgesia (PCA) after lower abdominal surgery. METHODS: Eighty adult patients undergoing lower abdominal surgery were randomly allocated to one of four groups to receive analgesics with PCA pumps. Patients in group I received IV tramadol, group II patients IV fentanyl, group III patients epidural tramadol, and group IV patients an epidural infusion of 0.125% ropivacaine + 2 microg ml(-1) fentanyl combination. Analgesic effectiveness and side-effects were assessed at 1, 2, 3, 4, 5, 6, 8, 12, 16, 20, and 24 hours after surgery. RESULTS: Adequate analgesia was achieved in all groups. The analgesia was highest in group IV (p < 0.05), and lowest in group III patients (p < 0.05). Eleven patients (55%) in group I and eight patients (40%) in group II suffered from nausea/vomiting. CONCLUSION: Although adequate pain relief was achieved with all regimens that were used in the study, intravenous tramadol and intravenous fentanyl are associated with a high incidence of nausea and vomiting.