Tramadol overdose in total knee arthroplasty: A case report

Area of Science:

• Nephrology
• Geriatrics
• Pharmacology

Background:

• Tramadol is a common postoperative analgesic with a generally favorable safety profile.
• Overdose can cause central nervous system depression, a risk amplified in patients with chronic kidney disease (CKD).
• Elderly individuals face heightened risks due to age-related pharmacokinetic and pharmacodynamic changes.

Observation:

• A 77-year-old male with stage 3 CKD developed unconsciousness and respiratory depression on postoperative day 3 after total knee arthroplasty.
• Investigations ruled out other causes, and elevated serum tramadol levels indicated opioid toxicity.
• The patient's condition improved with supportive care, including removal of a buprenorphine patch and prophylactic intubation.

Findings:

• Impaired renal clearance in CKD patients potentiates tramadol accumulation and toxicity.
• This case demonstrates severe tramadol toxicity in an elderly patient with stage 3 CKD.
• Judicious use, vigilant monitoring, and dose adjustments are crucial for managing tramadol in this population.

Implications:

• Clinicians must exercise caution when prescribing tramadol to elderly CKD patients.
• Individualized dosing and close monitoring of renal function are essential to prevent adverse events.
• Heightened awareness of opioid toxicity is critical for postoperative patients with neurological changes.