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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
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.
Background:
Pain control for paediatric patients undergoing tonsillectomy remains problematic. Tramadol is reported to be an effective analgesic and to have a side-effect profile similar to morphine, but is currently not licensed for paediatric use in the UK.
Methods:
We conducted a prospective, double-blind, randomized controlled trial in children who were scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and after obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug, we recruited 20 patients each into morphine (0.1 mg.kg(-1)), tramadol (1 mg.kg(-1)) and tramadol (2 mg.kg(-1)) groups. These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg.kg(-1)) rectally. The postoperative pain scores, analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting, as well as antiemetic requirements, were noted at 4-h intervals until discharge.
Results:
There were no statistically significant differences in age, weight, type of operation or induction of anaesthesia, 4-h sedation and pain scores and further analgesic requirements. There were no episodes of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% versus 40%, P=0.03) compared with both tramadol groups.
Conclusions:
Tramadol has similar analgesic properties, when compared with morphine. The various pharmaceutical presentations and the availability as a noncontrolled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.