Add on Tramadol to ropivacaine in serratus anterior muscle block for modified radical mastectomy patients improves analgesia: Study

Recent research study evaluated the use of tramadol as an adjuvant to ropivacaine in serratus anterior muscle (SAM) blocks for patients undergoing modified radical mastectomy (MRM) surgeries. The study compared the postoperative morphine consumption, pain scores, time to first analgesic request, and adverse events between the group receiving tramadol-ropivacaine and the group receiving only ropivacaine in the SAM block.

Seventy patients scheduled for elective MRM were randomly allocated to two groups. The study group (Group T) received a SAM block with 0.25% ropivacaine (18 ml) and tramadol 100 mg, while the control group (Group P) received a SAM block with 0.25% ropivacaine (18 ml) and saline. Patients were assessed for pain scores, analgesic requirement, time to first analgesic request, hemodynamic variables, and any side-effects at various time points postoperatively.

Study Results

The results showed that the cumulative morphine consumption over 24 hours was significantly less in Group T compared to Group P (3.06 ± 1.53 mg vs 4.34 ± 1.53 mg, p=0.001). The time to first analgesic requirement was longer in Group T (10.44 ± 5.04 hours vs 6.11 ± 2.73 hours, p<0.001). Pain scores were also significantly lower in Group T at all time points. There were no differences in the incidence of nausea, vomiting, or other adverse events between the two groups.

Conclusion

In conclusion, the addition of tramadol (100 mg) to ropivacaine for the SAM block in patients undergoing MRM reduced postoperative pain scores, decreased morphine consumption, and prolonged the time to first analgesic request, without any increase in side effects. The authors suggest that tramadol can be used as an effective adjuvant in SAM blocks to provide better postoperative analgesia in MRM surgeries.

Key Points -

The 3 key points of the research article are:

1. The study evaluated the use of tramadol as an adjuvant to ropivacaine in serratus anterior muscle (SAM) blocks for patients undergoing modified radical mastectomy (MRM) surgeries. The study compared the postoperative outcomes between the tramadol-ropivacaine group and the ropivacaine-only group.

2. The results showed that the group receiving the tramadol-ropivacaine SAM block had significantly lower postoperative morphine consumption, longer time to first analgesic request, and lower pain scores compared to the ropivacaine-only group. There were no differences in the incidence of adverse events between the two groups.

3. The authors conclude that the addition of tramadol (100 mg) to ropivacaine for the SAM block in MRM patients provided better postoperative analgesia without increasing side effects, and suggest that tramadol can be used as an effective adjuvant in SAM blocks for these surgeries.

Reference –

Singla V, Palta S, Saroa R, Kaushik R, Singh A. Role of tramadol as an adjuvant in ultrasound‑guided serratus anterior muscle block for modified radical mastectomy ‑ A randomized control trial. J Anaesthesiol Clin Pharmacol 2024;40:253‑7.