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Herve Bouaziz - One of the best experts on this subject based on the ideXlab platform.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED: Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.
Sebastien Robaux - One of the best experts on this subject based on the ideXlab platform.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED: Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.
G Torri - One of the best experts on this subject based on the ideXlab platform.
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interscalene Brachial Plexus Anesthesia and analgesia for open shoulder surgery a randomized double blinded comparison between levobupivacaine and ropivacaine
Anesthesia & Analgesia, 2003Co-Authors: Alessandra Casati, Guido Fanelli, Battista Borghi, Nicoletta Montone, Roberto Rotini, G Fraschini, Federico Vinciguerra, G Torri, Jacques E ChellyAbstract:UNLABELLED We compared the onset time and quality of interscalene Brachial Plexus block produced with levobupivacaine and ropivacaine in 50 patients undergoing open shoulder surgery randomly allocated to receive 30 mL of 0.5% levobupivacaine (n = 25) or 0.5% ropivacaine (n = 25) injected through a 20-gauge catheter placed into the interscalene sheath using a 18-gauge insulated and stimulating Tuohy introducer. The block was also prolonged after surgery using a patient-controlled interscalene analgesia with 0.125% levobupivacaine or 0.2% ropivacaine, respectively (basal infusion rate, 6 mL/h; bolus, 2 mL; lockout period, 15 min; maximum boluses per hour, three). Three patients (two with levobupivacaine [8%] and one with ropivacaine [4%]) failed to achieve surgical block within 45 min after the injection and were excluded. The onset time of surgical block was 20 min (10-40 min) with levobupivacaine and 20 min (5-45 min) with ropivacaine (P = 0.53). Rescue intraoperative analgesia (0.1 mg of fentanyl IV) was required in eight patients in each group (34%) (P = 0.99). Forty-two patients completed the 24-h postoperative infusion (22 with levobupivacaine and 20 with ropivacaine). Postoperative analgesia was similarly effective in both groups. Total consumption of local anesthetic infused during the first 24 h was 147 mL (144-196 mL) with levobupivacaine and 162 mL (144-248 mL) with ropivacaine (P = 0.019), with a ratio between boluses received and requested of 0.8 (0.4-1.0) and 0.7 (0.4-1.0), respectively (P = 0.004). The degree of motor block of the operated limb was deeper with levobupivacaine than ropivacaine when starting postoperative analgesia; however, no further differences in degree of motor function were observed between the two groups. We conclude that 30 mL of levobupivacaine 0.5% induces an interscalene Brachial Plexus Anesthesia of similar onset and intensity as the one produced by the same volume and concentration of ropivacaine. Postoperative interscalene analgesia with 0.125% levobupivacaine results in similar pain relief and recovery of motor function with less volume of local anesthetic than with 0.2% ropivacaine. IMPLICATIONS This prospective, randomized, double-blinded study demonstrates that 30 mL of 0.5% levobupivacaine produces an interscalene Brachial Plexus block of similar onset and quality as the one produced by the same volume of 0.5% ropivacaine. When prolonging the block after surgery, 0.125% levobupivacaine provides adequate pain relief and recovery of motor function after open shoulder surgery, with less volume infused during the first 24 h after surgery than 0.2% ropivacaine.
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nerve stimulator and multiple injection technique for upper and lower limb blockade failure rate patient acceptance and neurologic complications study group on regional Anesthesia
Anesthesia & Analgesia, 1999Co-Authors: G Fanelli, A Casati, P Garancini, G TorriAbstract:UNLABELLED: To evaluate the failure rate, patient acceptance, effective volumes of local anesthetic solution, and incidence of neurologic complications after peripheral nerve block performed using the multiple injection technique with a nerve stimulator, we prospectively studied 3996 patients undergoing combined sciatic-femoral nerve block (n = 2175), axillary blocks (n = 1650), and interscalene blocks (n = 171). The success rate and mean injected volumes of local anesthetic were: 93% with 22.6 +/- 4.5 mL in the axillary, 94% with 24.5 +/- 5.4 mL in the interscalene, and 93% with 28.1 +/- 4.4 mL in the sciatic-femoral nerve blocks. Patients receiving combined sciatic-femoral nerve block showed more discomfort during block placement and worse acceptance of the anesthetic procedure than patients receiving Brachial Plexus Anesthesia. During the first month after surgery, 69 patients (1.7%) developed neurologic dysfunction on the operated limb. Complete recovery required 4-12 wk in all patients but one, who required 25 wk. The only variable showing significant association with the development of postoperative neurologic dysfunction was the tourniquet inflation pressure ( 400 mm Hg, odds ratio 2.9, 95% confidence intervals 1.6-5.4; P 90% with a volume of <30 mL of local anesthetic solution and an incidence of transient neurologic complication of <2%. IMPLICATIONS: Based on a prospective evaluation of 3996 consecutive peripheral nerve blocks, the multiple injection technique with nerve stimulator allows for up to 94% successful nerve block with <30 mL of local anesthetic solution. Although the data collection regarding neurologic dysfunction was limited, the withdrawal and redirection of the stimulating needle was not associated with an increased incidence of neurologic complications. Sedation/analgesia should be advocated during block placement to improve patient acceptance.
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pulmonary function changes after interscalene Brachial Plexus Anesthesia with 0 5 and 0 75 ropivacaine
Anesthesia & Analgesia, 1999Co-Authors: A Casati, Valeria Cedrati, Marco Berti, Guido Fanelli, Giorgio Aldegheri, G TorriAbstract:The purpose of this investigation was to compare, in a prospective, double-blinded fashion, 0.5% and 0.75% ropivacaine with 2% mepivacaine to determine their effects on respiratory function during interscalene Brachial Plexus (IBP) Anesthesia. With ethical committee approval and written, informed co
Philippe Nouguier - One of the best experts on this subject based on the ideXlab platform.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED: Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.
Eric Viel - One of the best experts on this subject based on the ideXlab platform.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.
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tramadol added to 1 5 mepivacaine for axillary Brachial Plexus block improves postoperative analgesia dose dependently
Anesthesia & Analgesia, 2004Co-Authors: Sebastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, Herve BouazizAbstract:UNLABELLED: Adjuncts to local anesthetics for peripheral Plexus blockade may enhance the quality and duration of Anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to Brachial Plexus Anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under Brachial Plexus Anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of Anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for Brachial Plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral Plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for Brachial Plexus Anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.