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Preemptive analgesia with tramadol and fentanyl in pediatric neurosurgery
A Chiaretti1, L Viola, D Pietrini
1Pediatric Intensive Care Unit, Gemelli Hospital, Rome, Italy.
Insights
Preemptive analgesia with tramadol or fentanyl effectively manages pain in pediatric neurosurgery. Continuous infusion tramadol showed better efficacy and fewer side effects than bolus, while fentanyl was superior for postoperative pain control.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Preemptive analgesia aims to prevent pain sensitization by administering analgesics before painful stimuli.
- Opioid use in pediatric neurosurgery for preemptive analgesia is understudied.
- Tramadol and fentanyl are synthetic opioids with pain-inhibitory mechanisms.
Purpose of the Study:
- To evaluate the preemptive effects of tramadol and fentanyl in children undergoing major neurosurgical operations.
- To compare different administration protocols for tramadol (bolus vs. continuous infusion) and fentanyl (continuous infusion).
Main Methods:
- A randomized, prospective trial involving 42 children undergoing neurosurgery.
- Three treatment groups: tramadol bolus (1 mg/kg), tramadol continuous infusion (150 microg/kg/h), and fentanyl continuous infusion (2 microg/kg/h).
- Treatments administered during general anesthesia; postoperative pain assessed using behavioral and hemodynamic parameters.
Main Results:
- Only 2 children required additional postoperative analgesia.
- Continuous infusion tramadol demonstrated improved efficacy and reduced adverse effects compared to bolus administration.
- Fentanyl proved more effective than tramadol for postoperative pain management.
- No significant side effects were observed, except for increased nausea and vomiting in the tramadol bolus group.
Conclusions:
- Preemptive analgesia is a viable strategy for acute pain management in pediatric neurosurgery.
- Continuous infusion of tramadol is preferable to bolus administration for better efficacy and tolerability.
- Fentanyl offers superior postoperative pain relief compared to tramadol in this patient population.
Abstract:
Preemptive analgesia is based on administration of an analgesic before a painful stimulus generates, so as to prevent the subsequent rebound mechanism. Tissue injury results in disruption of the processing mechanisms of noxious stimuli afferent to the CNS (central nervous system) by way of an increase of inputs in the spinal cord. These reactions may be reduced by the administration of opioids. Few studies on preemptive analgesia with opioids in children are available, and none of them is concerned with pediatric neurosurgery. Tramadol and fentanyl are synthetic opioids which are relatively new and act through the activation of pain-inhibitory mechanisms. We conducted a randomized, prospective trial on the preemptive effects in children of these two analgesic drugs, administered according to three different protocols: tramadol as a bolus (1 mg/kg); tramadol by continuous infusion (150 microg/kg per h); fentanyl by continuous infusion (2 microg/kg per h). In all, 42 children undergoing major neurosurgical operations were enrolled in the study, 14 in each treatment group. Each treatment was started at the induction of general anesthesia and continued throughout the entire duration of the operation. The postoperative pain evaluation was conducted in the Pediatric Intensive Care Unit at the end of the surgical operations and involved comparison of any changes in behavioral (AFS scale and CHEOPS score) and hemodynamic (heart rate, respiratory rate, systolic and diastolic arterial pressure, oxygen saturation, O(2) and CO(2) partial pressure) parameters. Only 2 children, both in group A, needed further drug administration postoperatively. No significant side effects were noticed in any of the three groups, except that in group A there was a higher incidence of nausea and vomiting. Tramadol efficacy seems to be better when it is administered in continuous infusion; this treatment modality also leads to fewer adverse effects. Fentanyl, in contrast, proved to be superior to tramadol in the treatment of postoperative pain. In conclusion, preemptive analgesia is a valid technique for the treatment of acute pain in children undergoing major neurosurgical operations.