Comparison of ropivacaine, ropivacaine plus tramadol and ropivacaine plus morphine in patients undergoing minor hand surgery

In our study we aimed to compare the effects of ropivacaine alone, ropivacaine plus tramadol HCl, and ropivacaine plus morphine HCl used as intravenous regional anesthesia (IVRA), on duration to the initiation of analgesia, total analgesia time, analgesic requirement, sedation levels and hemodynamic parameters. 53 patients undergoing minor hand surgery were included into the study. Patients were randomly divided into three groups to receive 40 ml of ropivacaine 0.2 % (Group R, n=18), ropivacaine 0.2 % plus 1 mg/kg tramadol HCl (Group RT, n=18), and ropivacaine 0.2 % plus 0.1 mg/kg morphine HCl (Group RM, n=17) as IVRA. Following the injection, the durations for the initiation of analgesia were recorded. Levels of sedation, analgesia (VAS) and hemodynamic parameters were recorded in 5 minute intervals throughout first 35 minutes intraoperatively and at 1, 5, 10, 15, 20, 30, 45 and 60th minutes postoperatively. Patients were asked about the initiation of pain and requirements of analgesic at the first postoperative day. The duration to the initiation of analgesia was similar between the groups. Total analgesia time was found to be 304.0 ± 317.6 min in Group R, 327.0 ± 316.5 min in Group RT, and 635.9 ± 492.3 min in Group RM. The difference between Group R and RM was statistically significant (p<0.05). Analgesic requirements were similar between the groups (p>0.05). Mild local anesthetic toxicity was observed in Group RM in two patients. We conclude that, when used as IVRA, ropivacaine alone or with tramadol or morphine produced similar analgesia and surgery conditions, and ropivacaine plus morphine had more adverse effects besides its longer duration of analgesia.