Abstract
Purpose: To evaluate the adverse effect profile of tramadol by patient-controlled analgesia (PCA) with administration of the loading dose either intraoperatively or postoperatively.
Methods: Sixty adult patients scheduled for elective abdominal surgery were enrolled into this prospective, randomized, double blind study. The patients were anesthetized in a similar manner. At the beginning of wound dosure, the patients were randomly allocated to receive 5 mg·kg−1 tramadol (Group 1) or normal saline (Group 2). In the post-anesthesia care unit (PACU), when patients in either group complained of pain, 30 mg·ml−1 tramadol iv were given every three minutes until visual analogue scale (VAS) 3, followed by tramadol PCA with bolus dose of 30 mg and five minute lockout interval. Pain control and adverse effect assessments were done in the PACU and every six hours for 48 hr post drug by an independent observer.
Results: The loading dose was 290±45 mg in Group 1 and 315±148 mg in Group 2. In PACU, more nausea/vomiting both in terms of incidence (13/30, 43% vs 2/30, 6.6%,P<0.05) and severity (nausea/vomiting score 2.5±2.0 vs 0.2±0.6,P<0.05) was observed in patients with postoperative loading than in those with intraoperative loading of tramadol.
Conclusion: Administering the loading dose of tramadol during surgery decreases the nausea/vomiting associated with high dose of tramadol and improves the quality of tramadol PCA in the relief of postoperative pain.
Résumé
Objectif: Évaluer le profil des effets indésirables du tramadol, utilisé pour l’analgésie contrôlée par le patient (ACP) après une dose de charge peropératoire ou postopératoire.
Méthode: Ont participé à l’étude prospective, randomisée et à double insu 60 patients adultes admis pour une intervention abdominale planifiée. L7rsanesthésie a été similaire pour tous. Au début de la fermeture de la plaide chirurgicale, les patients, répartis au hasard, ont reçu 5 mg·kg−1 de tramadol (Groupe 1) ou un soluté physiologique (Group 2). À la salle de réveil, on a administré sur demande 30 mg·ml−1 de tramadoliv à toutes les trois minutes jusqu’à ce que l’échelle visuelle analogique (EVA) indique ⩾ 3. Puis, le tramadol ACP a été donné en bolus de 30 mg alternant avec une période réfractaire de cing minutes. Le contrôle de la douleur et les effets négatifs ont été évalués par un observateur impartial à la salle de réveil et toutes les six heures pendant 48 h après l’administration du médicament.
Résultats: La dose de charge était de 290±45 mg dans le Groupe 1 et de 315±148 mg dans le Groupe 2. On a noté plus de nausées et de vomissements, en termes d’incidence (13/30, 43 % vs 2/30, 6,6 %;P<0,05) et de sévérité (score de 2,5±2,0 vs 0,2±0,6;P<0,05) dans le cas de la dose de charge postopératoire de tramadol que dans le cas de la dose peropératoire.
Conclusion: L’administration peropératoire d’une dose de charge de tramadol permet de r eduire les nausées et vomissements associés à de fortes doses de tramadol et améliore la qualité analgésique postopératoire de ce médicament en ACP.
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This study was carried out at Department of Anesthesia, Show-Chwan Memorial Hospital, Changhua, Waiwan, R.O.C.
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Pang, WW., Mok, M.S., Huang, S. et al. Intraoperative loading attenuates nausea and vomiting of tramadol patient-controlled analgesia. Can J Anesth 47, 968–973 (2000). https://doi.org/10.1007/BF03024867
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DOI: https://doi.org/10.1007/BF03024867