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Comparative Study Between Systemically and Perineurally Administered Tramadol as an Adjunct in Ultrasound Guided Supraclavicular Brachial Plexus Block

Background:brachial plexus block remains the only practical alternative to general anesthesia for significant surgery on the upper limb. It can be extremely useful in patients with significant co-morbidities such as severe respiratory and cardiovascular disease, morbid obesity and in those with potential airway difficulties. 
Aim of the Work:comparing the efficacy of systemically administered tramadol and perineurally administered tramadol as an adjunct to bupivacaine in supraclavicular brachial plexus blocks on onset of sensory, motor blockade and postoperative analgesia along with demand for rescue analgesic in the postoperative period. 
Patients and Methods: 
 
Group A: bupivacaine 0.5%-20 ml + lidocaine 2% -5 ml for block. 
Group B: bupivacaine 0.5%-20 ml + lidocaine 2% -5 ml mixture for block and tramadol (100 mg) diluted to 10 ml intravenously. 
Group C: bupivacaine 0.5%-20 ml+ lidocaine 2% -5 ml+ tramadol (100 mg). 
 
Results: In motor onset block there was a highly significant difference between the three study groups. Also, it was highly significant faster in group C where tramadol given perineurally compared with those of placebo and systemic tramadol administrations. Duration of sensory block there was a highly significant difference between the three study groups. It was highly significant longer in group C where tramadol given perineurally compared with those of placebo and systemic tramadol administrations. Regarding First request of rescue analgesia there was a highly significant difference between the three study groups. 
Conclusion:the mixture of tramadol, bupivacaine and lidocaine injected perineurally for supraclavicular brachial plexus block hastens the onset of sensory block, motor block and provides a longer duration of motor blockade and postoperative analgesia as compared to other two groups in which tramadol was either injected intravenously (systemic group) or was not given at all (control group).