Canadian Journal of Anaesthesia

, Volume 45, Issue 12, pp 1168–1175 | Cite as

Perioperative antinociceptive effects of tramadol. A prospective, randomized, double-blind comparison with morphine

  • Mohamed Naguib
  • Mohamed Seraj
  • Mounir Attia
  • Abdulhamid H. Samarkandi
  • Mustafa Seet
  • Randa Jaroudi
Reports of Investigation

Abstract

Purpose

To compare the efficacy of tramadol and morphine for intra-and postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

Methods

In a prospective, randomized, double-blind study 100 patients were allocated randomly into two groups. Ten minutes before induction of anaesthesia, patients in group I received 100 mg tramadol and those in group 2 received 10 mg morphineiv. Anaesthesia was induced with 5 mg·kg−1 thiopental and was maintained with O2, N2O plus isoflurane with additional doses of tramadol or morphine as decided by the attending anaesthetist. Postoperatively, patients in group I and group 2 received tramadol and morphine, respectively, from a patient-controlled analgesia (PCA) device. Pain, analgesic consumption, vital signs and side effects were recorded postoperatively for 24 hr.

Results

Intraoperative consumption of tramadol and morphine were 137 ± 37 and 12.2 ± 3 mg, respectively. Compared with morphine, patients receiving tramadol had higher blood pressures and required greater mean ETiso to control haemodynamic variables (P < 0.05). Postoperatively, there were no differences in observer pain score or visual analogue pain score during the first 24 hr between groups except at 30, 45, and 90 min where patients in the tramadol group reported higher pain scores (P < 0.05). The cumulative, 24 hr PCA consumption was III ± 93 and 7.5 ± 6.6 mg of tramadol and morphine, respectively.

Conclusions

There was no difference between the use of tramadol and morphine to treat pain after laparoscopic cholecystectomy from 90 min after the end of surgery. Morphine was more effective than tramadol as an intraoperative analgesic.

Résumé

Objectif

Comparer l’efficacité du tramadol et de la morphine pour l’analgésie peropératoire et postopératoire de patients devant subir une cholécystectomie laparoscopique.

Méthode

Lors d’une étude prospective, randomisée et en double aveugle, 100 patients ont été répartis au hasard en deux groupes. Dix minutes avant l’induction de l’anesthésie, les patients du groupe I ont reçu 100 mg de tramadol et ceux du groupe 2, 10 mg de morphineiv. Lanesthésie a été induite avec 5 mg·kg−1 de thiopental et a été maintenue avec un mélange d’O2 et de N2O plus de l’isoflurane et des doses supplémentaires de tramadol ou de morphine selon la décision de l’anesthésiste traitant. Après l’intervention, les patients des groupes 1 et 2 ont reçu respectivement du tramadol et de la morphine à l’aide d’un dispositif d’analgésie contrôlée par le patient (ACP). En période postopératoire également, on a enregistré pendant 24 heures la douleur, la consommation d’analgésiques, les signes vitaux et les effets secondaires.

Résultats

La consommation peropératoire de tramadol et de morphine a été de 137 ± 37 et de 12,2 ± 3 mg, respectivement. Comparativement, les patients qui ont reçu du tramadol ont présenté une tension artérielle plus élevée et ont eu besoin d’isofluraneTE (télé-expiratoire) de moyenne plus élevée pour contrôler les variables hémo-dynamiquesP < 0,05). Il n’y a pas eu de différence de douleur postopératoire entre les groupes d’après les niveaux enregistrés par un observateur ou par l’échelle visuelle analogique, pendant les 24 premières heures, sauf à 30, 45 et 90 min alors que les patients du groupe ayant reçu du tramadol ont éprouvé des douleurs plus intenses (P < 0,05). La consommation totale des 24 h d’ACP a été de 111 ±93 et de 7,5 ± 6,6 mg de tramadol et de morphine, respectivement.

Conclusion

À partir de 90 min après la chirurgie, il n’y a pas de différence entre l’usage de tramadol ou de morphine pour traiter la douleur consécutive à la cholécystectomie laparoscopique. La morphine a été plus efficace que le tramadol en tant qu’analgésique peropératoire.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  • Mohamed Naguib
    • 1
  • Mohamed Seraj
    • 1
  • Mounir Attia
    • 1
  • Abdulhamid H. Samarkandi
    • 1
  • Mustafa Seet
    • 1
  • Randa Jaroudi
    • 2
  1. 1.Department of AnaesthesiaKing Saud University, College of Medicine at King Khalid University HospitalSaudi Arabia
  2. 2.Department of PharmacyKing Saud University, College of Medicine at King Khalid University HospitalSaudi Arabia

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