Preoperative intravenous tramadol combined with intramuscular diclofenac sodium reduces intraoperative loading dose of tramadol-PCA: A randomized trial [Ameliyat öncesi intravenöz tramadol ve intramusküler diklofenak sodyum uygulanmasi tramadol-hasta kontrollü analjezinin intraoperatif yükleme dozunu azaltir: Randomize çalişma]

Objective: intraoperative administration of loading dose of iv tramadol-pca (patient controlled analgesia) reduces the incidence of side effects. optimum intraoperative single dose is 2.5 mg kg-1,which can be reduced to 1.25 mg kg-1 with adjuvant agents. our aim is to verify the hypothesis asserting the use of 1 mg kg-1 intravenous tramadol and 75 mg intramuscular diclofenac sodium 30 minutes before surgery would reduce the intraoperative loading dose of tramadol to provide adequate analgesia,while reducing the need for postoperative tramadol-pca. method: 35 to 65-year-old,45 asa i and ii patients,undergoing elective abdominal hysterectomy under general anesthesia were enrolled. all patients received 1 mg kg' intravenous tramadol and 75 mg intramuscular diclofenac sodium 30 minutes before surgery. patients were randomized into three groups to receive either normal saline (group i),iv tramadol 0.5 mg kg-1 (group ii) or 1 mg kg-1 (group iii) 30 minutes before the end of surgery. the total tramadol-pca consumption in 24 hours was our primary outcome measure. secondary outcome measures were emergence times,sedation scores,ponv,time to first activation ofpca,vrss in 24 hour period postoperatively and rescue analgesic medication. results: vrs score in group iii was found lower at 60th' min (p<0.001).the scores were similar in the other follow-up times. demanded bolus doses in group iii in 24 hour was lower than those of group i and ii (p<0.001). the total amount of tramadol consumed in 24 hour was lower in group iii (169 (78.2-336) mg) than in group i (323.2 (174.2-630) mg) and ii (352 (243.5-622.5) mg). secondary outcome measures were similar among the groups. conclusion: in our study,effective analgesia was provided by simultaneous administration of the 1 mg kg-1 iv tramadol and 75 mg im diclofenac sodium 30 minutes before surgery,in combination with 1 mg kg-1 tramadol intraoperative loading dose,while lowering 24 hour tramadol consumption.