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Published on: November 6, 2019

Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine

Thomas Engelhardt1, Elizabeth Steel, Graham Johnston

  • 1Royal Aberdeen Children's Hospital, Aberdeen, UK. t.engelhardt@abdn.ac.uk

Paediatric Anaesthesia
|March 19, 2003
PubMed

Insights

Tramadol offers comparable pain relief to morphine for children after tonsillectomy, with fewer side effects like vomiting. This suggests tramadol could be a valuable option for pediatric anesthesia if licensed.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Pharmacology

Background:

  • Effective pain management for pediatric tonsillectomy patients is a significant clinical challenge.
  • Tramadol is recognized for its analgesic efficacy and a side-effect profile comparable to morphine.
  • Currently, tramadol lacks UK licensure for pediatric use.

Purpose of the Study:

  • To compare the efficacy and safety of tramadol versus morphine for postoperative pain control in children undergoing tonsillectomy.
  • To evaluate postoperative pain scores, analgesic requirements, sedation, and adverse events.

Main Methods:

  • A prospective, double-blind, randomized controlled trial involving 60 pediatric patients undergoing elective tonsillectomy or adenotonsillectomy.
  • Patients were allocated to receive either morphine (0.1 mg.kg(-1)) or tramadol (1 mg.kg(-1) or 2 mg.kg(-1)) post-anesthesia induction, alongside rectal diclofenac.
  • Postoperative outcomes including pain, sedation, respiratory status, and gastrointestinal side effects were monitored.

Main Results:

  • No statistically significant differences were observed in pain scores, sedation levels, or additional analgesic needs between the morphine and tramadol groups.
  • No instances of respiratory depression were reported across all treatment groups.
  • Vomiting occurred significantly more frequently in the morphine group (75%) compared to the tramadol groups (40%) after discharge to the ward (P=0.03).

Conclusions:

  • Tramadol demonstrates comparable analgesic properties to morphine in the pediatric population undergoing tonsillectomy.
  • Tramadol's favorable side-effect profile, particularly reduced vomiting, and availability as a non-controlled substance position it as a potentially valuable agent for pediatric anesthesia.
  • Licensure of tramadol for pediatric use in the UK could enhance postoperative pain management options.
Abstract

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