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Comparison of caudal vs intravenous tramadol administered either preoperatively or postoperatively for pain relief in
Yasemin Güneş1, Murat Gündüz, Hakki Unlügenç
1Department of Anaesthesiology, Faculty of Medicine, Cukurova University, Balcali Adana, Turkey.
Insights
Caudal tramadol offers superior and extended pain relief for hypospadias repair compared to intravenous administration. Timing of caudal tramadol, pre- or post-surgery, did not significantly alter its effectiveness.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Care
Background:
- Hypospadias repair in young boys requires effective postoperative pain management.
- Comparing different routes and timings of tramadol administration is crucial for optimizing analgesia.
Purpose of the Study:
- To compare the efficacy of caudal versus intravenous tramadol for postoperative pain relief in pediatric hypospadias surgery.
- To evaluate the impact of pre- versus postoperative administration of caudal tramadol.
Main Methods:
- A randomized controlled trial involving 134 boys aged 1-3 years undergoing hypospadias repair.
- Four groups received either caudal or intravenous tramadol, administered pre- or postoperatively.
- Pain and sedation scores were monitored for 24 hours post-surgery using an Objective Pain Score (OPS).
Main Results:
- Caudal tramadol groups showed significantly lower OPS at 3 hours post-surgery compared to intravenous groups (P < 0.05).
- The duration of postoperative analgesia was significantly longer with caudal tramadol administration (P = 0.001).
- The timing of caudal tramadol administration (pre- vs. postoperative) did not affect the duration of analgesia.
Conclusions:
- Caudal tramadol provides superior and longer-lasting postoperative analgesia than intravenous tramadol in pediatric hypospadias repair.
- Preoperative administration of caudal tramadol offers no discernible clinical advantage over postoperative administration.
Background:
In this study we compared caudal with intravenous (i.v.) tramadol given pre- or postoperatively for pain relief in boys having hypospadias repair.
Methods:
The study was approved by the Ethics Committee and informed written consent was obtained from the parents of each patient. Patients (n = 134), aged 1-3 years, American Society of Anesthesiologists (ASA) physical status I, scheduled for hypospadias surgery were recruited. The patients were randomly allocated to one of the four groups: group I (n = 33), received 2 mg.kg(-1) (0.5 ml.kg(-1)) of caudal tramadol after the surgical procedure was completed, group II (n = 33) received 2 mg.kg(-1) (0.5 ml.kg(-1)) of caudal tramadol before incision, group III (n = 34) received 2 mg.kg(-1) tramadol intravenously, after surgery and group IV (n = 34) received 2 mg.kg(-1) tramadol intravenously, after anaesthesia induction. When the patients were fully awake in the recovery area, heart rate, arterial pressure, peripheral oxygen saturation, respiratory rate, pain and sedation scores were recorded at 5, 10, 15, 30, 60 min, and 2, 3, 4, 6, 12 and 24 h postoperatively and side-effects were noted. Pain was assessed using an objective pain score (OPS).
Results:
The OPS were lower in caudal tramadol groups than in i.v. tramadol groups only at 3 h (P < 0.05). The duration of postoperative analgesia was longer in the caudal groups than in the i.v. groups (P = 0.001). However, the duration of postoperative analgesia was unaffected by the timing of administration.
Conclusions:
Caudal tramadol provides better and longer lasting postoperative analgesia than i.v. tramadol. These results also suggest that preoperative caudal tramadol did not provide any clinically perceptible benefits compared with postoperative caudal tramadol.
