Comparison of intrathecal bupivacaine with tramadol and bupivacaine with dexamethasone for post cesarean section pain relief extension in elective cesarean sections under spinal anesthesia in resource limited setup: prospective observational study

Introduction: Spinal anesthesia provides the most reliable block for lower abdominal and orthopedic surgery. Spinal anesthesia reduces the risks associated with general anesthesia, such as aspiration and difficulty managing the airway. As a result, numerous adjuvants were added to local anesthetics, including epinephrine, phenylephrine, clonidine, opioids, dexamethasone, tramadol, and so on. The objective of this study is to compare the analgesic duration of spinal anesthesia with bupivacaine-tramadol and bupivacaine-dexamethasone to cesarean section pain. Methods: Institutional-based prospective cohort study was employed. Totally 164 participants has participated in this study. A consecutive sampling technique was employed. All obstetric patients undergoing elective caesarean surgery under spinal anesthesia and who will fulfill inclusion criteria were included in this study. The chi-squared, T-test, and survival analysis of Kaplan-Meier and log-rank test were used in the statistical analysis, which was carried out using SPSS version 26.0 Software. The reported values for the quantitative variables were expressed as mean +/- SD, while the count and percent values were used for the qualitative variables. A statistically significant value was defined as P < 0.05. Result: The total analgesia requirement within 24 hours for diclofenac, tramadol, morphine, and pethidine were analyzed and there was a statistically significant difference among the groups with all anti pains, P < 0.05. A survival analysis of a log-rank test was also computed to assess the mean analgesia request time between the groups. It revealed that the B-D group (mean time in minutes, 110.6 [95% CI, 106.3-120.4]; P = 0.02) had a shorter mean time to first rescue analgesic administration than the B-T group (mean time in minutes, 136.6 [95% CI, 123.6-142.5]; P = 0.02). Conclusion: This study found that using tramadol as an adjuvant with bupivacaine for intrathecal route significantly extended duration of pain-free period after subarachnoid anesthesia, as compared to 4 mg dexamethasone added to intrathecal bupivacaine.