Abstract
Purpose
To compare subcutaneous PCA tramadol with subcutaneous PCA morphine for postoperative pain relief after major orthopaedic surgery and for the incidence of side-effects.
Methods
In a double-blind randomised controlled study 40 patients (20 in each group) self-administered either tramadol or morphine for 72 hr after surgery viasc PCA The following variables were recorded at various time intervals: (i) pain score by means of a visual analogue scale, (ii) drug consumption and total PCA demands, (iii) vital signs (blood pressure and heart rate), (iv) oxygen saturation and respiratory rate, and (v) side-effects (sedation, nausea/vomiting, pruritus, urinary retention and constipation).
Results
Both drugs provided effective analgesia. The mean consumption in the first 24 hr was 792 ± 90 mg tramadol and 42 ± 4 mg morphine. Thereafter, consumption of both drugs declined markedly. Moderate haemodynamic changes were observed in both the tramadol and morphine groups (with a maximum 20% decrease in mean blood pressure and a maximum 17% increase in heart rate) during the 72 hr period. Both tramadol and morphine were associated with a clinically and statistically significant (P < 0.001) decrease in oxygen saturation, but without changes in respiratory rates. Desaturation was less marked with tramadol. Tramadol appeared to cause more nausea and vomiting than morphine. Sedation was mild and only seen during the first few hours after surgery in both groups.
Conclusion
Tramadol is an effective analgesic agent for the relief of acute postoperative pain when administered by PCA via the subcutaneous route. Under these conditions tramadol behaves much like morphine with a similar side-effect profile.
Résumé
Objectif
Comparer le tramadol et la morphine administrés par ACP par voie sous-cutanée pour le soulagement des douleurs postopératoires en chirurgie orthopédique majeure et leurs effets secondaires.
Méthodes
Dans cette étude randomisée, contrôlée et en double aveugle, 40 patients (20 dans chaque groupe) se sont administrés du tramadol ou de la morphine par ACP par voie sous-cutanée pendant les 72 premières heures postopératoires. Les paramètres suivants ont été mesurés à intervalles réguliers: (i) le score de douleur par échelle visuelle analogue, (ii) les doses d’analgésiques utilisées par les patients et le nombre total de demandes d’ACP, (iii) les signes vitaux (tension artérielle, fréquence cardiaque), (iv) la saturation d’oxygène et la fréquence respiratoire, (v) les effets secondaires (sédation, nausées et vomissements, prurit, rétention urinaire et constipation).
Résultats
Le tramadol et la morphine ont montré tous les deux une analgésie efficace. La dose moyenne utilisée dans les premières 24 heures postopératoires était 792 ± 90 mg de tramadol et 42 ± 4 mg de morphine. Par la suite les doses utilisées ont rapidement décliné pour les deux médicaments. Des modifications hémodynamiques modérées ont été observées dans les deux groupes (réduction de 20% de la tension arterielle et augmentation de 17% de la fréquence cardiaque). Le tramadol et la morphine ont tous les deux entrainé une diminution de la saturation d’oxygène (P < 0.001) mais sans changement de la fréquence respiratoire. La désaturation était moins importante avec le tramadol. Le tramadol a semblé causer plus de nausées et vomissements que la morphine. Le degré de sédation a été modéré dans les deux groupes et n’a duré que quelques heures après la chirurgie.
Conclusion
Le tramadol est un analgésique efficace quand il est administré par ACP par voie sous-cutanée. Dans ces conditions le tramadol est semblable à la morphine avec des effets secondaires comparables.
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Hopkins, D., Shipton, E.A., Potgieter, D. et al. Comparison of tramadol and morphine via subcutaneous PCA following major orthopaedic surgery. Can J Anaesth 45, 435–442 (1998). https://doi.org/10.1007/BF03012579
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DOI: https://doi.org/10.1007/BF03012579