ANALGESIC EFFICACY OF TRAMADOL IN PEDIATRIC TONSILLECTOMY WITH ADENOIDECTOMY
Abstract
Background: Tonsillectomy is one of the most commonly performed surgical prcedures in childhood. Acute pain after tonsillectomy and adenoidectomy can be treated with non-opioid and opioid analgesics. Our hypothesis stated that tramadol iv after induction of anaesthesia has superior analgesic effect compared to acetaminophen.
Methods: In a prospective, randomised study we compared analgesic efficacy of tramadol (group T: 2 mg/kgBW iv) and acetaminophen (group A: elixir 15 mg/kgBW before op. procedure) in a group of 108 children (age 3-7 years). Exclusion critheria: allergy, liver or kidney failure, epilepsy, febrile convulsions. A standard anaesthetic technique was used: propofol, alfentanil, vecuronium, positive pressure ventilation with 60% nitrous oxide in oxygen. After the procedure each child received acetaminophen suppositories (10 mg/kgBW/4-6h) and combined suppositories. Monitoring: vital signs during and after op. procedure, pain intensity on the ward (facial pain score).
Results: There were no significant differences between the two groups in age distribution (mean age 5,2 years), ASA physical status, body weight, operative procedure, pain scores (VAS 6h after operative procedure; group T: 4,21±1,45; group A: 4,06±1,33), oxygen saturation, pulse frequency and the consumption of acetaminophen suppositories. Significant difference was in the consumption of combined suppositories (group T: 1,85±0,79; group A: 1,43±0,69, p=0,003).
Conclusion: Our study has shown, that tramadol is not a superior analgesic for the relief of posttonsillectomy pain in children compared to acetaminophen.
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References
Anderson B, Kanagasundarum S, Woolard G. Analgesic Efficacy of Paracetamol in Children Using Tonsillectomy as a Pain Model. Anaesth Intens Care 1996; 24: 669-73.
Morton NS. Prevention and control of pain in children. Br J Anaesth 1999; 83 (1): 118-29.
Feinstein R, Owens WD. Anesthesia for Ear, Nose, and Throat Surgery. In: Barash PG, Cullen BF, Stoelting RK, eds. Clinical Anesthesia. 2nd ed. Philadelphia: J.B. Lippincott company, 1992: 1113 - 25.
Šereg-Bahar M, Hočevar-Boltežar I, Jarc A, Fajdiga I. Velofaringealna insuficienca po operaciji žrelnice in nebnic. Medicinski razgledi 2000; 39: Suppl 3: 329-33.
Murthy P, Laing MR. Dissection tonsillectomy: pattern of post-operative pain, medication and resumption of normal activity. The Journal of Laryngology and Otology 1998; 112: 41-4.
Žarkovič S, Pečan M. Lajšanje pooperativne bolečine po posegih v maksilofacialnem področju. V: Krčevski-Škvarč N, Vintar N. Simpozij o lajšanju pooperativne bolečine. Ljubljana: B in M Povše, 1999: 114-18.
Brunsson I. Pooperativno zdravljenje bolečine pri otrocih. V: Krčevski-Škvarč N. 4. Seminar o bolečini. Splošna bolnišnica Maribor: APRINT, 2000: 217-27.
Stoelting RK, Miller RD. Basics of Anesthesia. New York: Churchill Livingstone, 1994: 343-55.
Shipton EA. Tramadol-Present and Future. Anaesth Intensive Care 2000; 28: 363-74.
Ferrari LR, Donlon JV. Metoclopramide Reduces the Incidence of Vomiting After Tonsillectomy in Children. Anesth Analg 1992; 75: 351-4.
Nikanne E, Kokki H, Tuovinen K. Postoperative pain after adenoidectomy in children. Br J Anaesth 1999; 82(6): 886-9.
P Jodal-Extröm B. Razvojne spremembe v fiziologiji otroka in njihov vpliv na anestezijo. V: Paver-Eržen V. Podiplomsko izoibraževanje iz anesteziologije-četrti tečaj. Ljubljana: B in M Povše, 1996: 116-24.
Pečan M. Akutna pooperativna bolečina. V: Paver-Eržen V. Podiplomsko izobraževanje iz anesteziologije, 5. tečaj. Portorož: Tiskarna B in M Povše, 1997: 181-94.
Bamigbade TA, Langford RM. The clinical use of tramadol hydrochloride. Pain Reviews 1998; 5: 155-82.
Scott LJ, Perry CM. Tramadol (A Review of its Use in Perioperative Pain).
Drugs 2000; 60(1): 139-76.
Viitanen H, Annila P. Analgesic efficacy of tramadol 2 mg/kg for paediatric day-case adenoidectomy. Br J Anaesth 2001; 86: 572-5.
Kremesec M. Akutna bolečina pri otrocih. V: Krčevski-Škvarč N. 4. Seminar o bolečini. Splošna bolnišnica Maribor: APRINT, 2000: 227-41.
Benedik J. Vpliv tramadola na zdravljenje pooperativne bolečine po odstranitvi žrelnice in nebnic pri otrocih [Mag thesis]. Ljubljana: Medicinska fakulteta; 2003.
Šarc L, Jamšek M, Grenc D, Brvar M. Smernice za zdravljenje zastrupitev s paracetamolom. Zdrav Vestn 2014; 83: 201-8.
Craig KD. The Facial Display of Pain. In: Finley GA, McGrath PJ. Measurement of Pain in Infants and Children, Progress in Pain Research and Management. Seattle: IASP Press, 1998 (10): 103-21.
Kain ZV, Cicchetti DV, McClain BC. Measurement of Pain in Children, State-of-the-art Considerations. Anesthesiology 2002; 96: 523-6.
Arana A, Morton NS, Hansen TG. Treatment with paracetamol in infants. Acta Anaesthesiol Scand 2001; 45: 20-9.
Toma AG, Blanshard J, Eynon-Lewis N, Bridger MW. Post-tonsillectomy pain: the first ten days. The Journal of Laryngology and Otology 1995; 109: 963-4.
Stehling LC. Management of the Airway. In: Barash PG, Cullen BF, Stoelting RK, eds. Clinical Anesthesia. 2nd ed. Philadelphia: J.B. Lippincott company, 1992: 685-708.
Kremesec M. Anestezija novorojenčka, dojenčka in otroka. V: Paver-Eržen V. Podiplomsko izobraževanje iz anesteziologije - četrti tečaj. Ljubljana: B in M Povše, 1996: 136-54.
Barsoum MW. Comparison of the efficacy and tolerability of tramadol, pethidine and nalbuphine in children with postoperative pain: an open randomised study. Clin Drug Invest 1995; 9: 183-90.
Morton NS, Camu F, Dorman T, et al. Ondansetron reduces nausea and vomiting after paediatric adenotonsillectomy. Paediatric Anaesthesia 1997; 7: 37-45.
Celiker V, Ornek N, Canbay O, Basgul E, Aypar U. Minimum effective dose od dexamethasone for preventing nausea and vomiting after adenotonsillectomy. Journal of Ankara medical school 2003; 25 (1): 21-6.
Culy CR, Bhana N, Plosker GL. Ondansetron: a review of its use as an antiemetic in children. Paediatr Drugs 2001; 3(6): 441-79.
Rawlinson E, Walker A, Skone R, Thillaivason A, Bagshaw O. A randomised controlled trial of two analgesic techniques for paediatric tonsillectomy. Anaesthesia 2011; 66(10): 919-24.
Carr AS, Courtman S, Holtby H. Guidelines on the prevention of post-operative vomiting in children. Association of Paediatric Anaesthetists of Great Britain and Ireland. http://www.apagbi.org.uk/sites/apagbi.org.uk/files/APA Guidelines on the Prevention of Postoperative Vomiting in CVhildren.pdf (accessed 08/11/2011).
De Witte JL, Schoenmaekers B, Sessler DI, Deloof T. The Analgesic Efficacy Of Tramadol is Impaired by Concurent Administration of Ondansetron. Anesth Analg 2001; 92: 1319-21.
Menghini F, Van Deenen D, Berger A, et al. Postoperative tramadol vs. diclofenac and propacetamol in paediatric tonsillectomy: comparison of efficacy and side effects (abstract). Br J Anaesth 1999; 82: Suppl 1: 153.
Pendeville PE, Von Montigny S, Dort JP, Veyckemans F. Double-blind randomized study of tramadol vs. paracetamol in analgesia after day-case tonsillectomy in children. Eur J Anaesthesiol 2000; 17(9): 576-82.
Ozkose Z, Akcabay M, Kemaloglu YK, Sezenler S. Relief of posttonsillectomy pain with low-dose tramadol given at induction of anesthesia in children. Int J Pediatr Otorhinolaryngol 2000; 53(3): 207-14.
Kokki H, Nikanne E, Tuovinen K. I.v. intraopertive ketoprofen in small children during adenoidectomy: a dose-finding study. Br J Anaesth 1998; 81: 870-4.
Mukherjee K, Esuvaranathan V, Streets C, Johnson A, Carr AS. Adenotonsillectomy in children: a comparison of morphine and fentanyl for peri-operative analgesia. Anaesthesia 2001; 56: 1181-201.
Khetani JD, Madadi P, Sommer DD, Reddy D, Sistonen J, Ross CJ. Apnea and oxygen desaturation in children treated with opioids after adenotonsillectomy for obstructive sleep apnea syndrome: a prospective pilot study. Paediatr Drugs 2012; 14(6): 411-5.
Williams DG, Hatch DI, Howard RF. Codeine phosphate in paediatric medicine. Br J Anaesth 2001; 86(3): 413-21.
Bhatia U, Patel KD. Peritonsillar infiltration with 0,25% Bupivacaine for preemptive analgesia in Paediatric patients undergoing tonsillectomy. NHL Journal of Medical Sciences 2014; 3(1): 12-15.
Solanki NS, Goswami M, Thaker N. Bupivacaine infiltration versus diclofenac suppository for post-tonsillectomy pain relief in paediatric patients. National Journal of Medical Research 2012; 2(1): 5-7.
Farmawy MS, Rashad MM. Preemptive analgesia by peritonsillar ketamine versus ropivacaine for post-tonsillectomy pain in children. Egyptian Journal of Anaesthesia 2014; 30(1): 1-5.
Kocum AI, Sener M, Caliskan E, Bozdogan N, Micozkadioglu D, Yilmaz I et al. Intravenous paracetamol and dipyrone for postoperative analgesia after day-case tonsillectomy in children: a prospective, randomised, double blind, placebo controlled study. Braz J Otorhinolaryngol 2013; 79(1): 89-94.
Moore A. Gabapentin and Post Tonsillectomy Pain-The Next Best Thing? Arch Trauma Res 2013; 1(4): 188-90.
Fatthallah MA, Elquesny KM, Abdelmageed WM, Elsayed MM. Preemptive single oral dose of gabapentin (600 mg) provides safe adequate analgesia for immediate post-tonsillectomy pain. Ain Shams Journal of Anesthesiology 2012; 5(1): 145-55.
Kishikova L, Smith MD, Fleming JC, O`Connell M. Analgesic Regimen and Readmission Following Tonsillectomy. International Journal of Otolaryngology & Neck Surgery 2013; 2: 121-5.
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