Abstract
Purpose
To compared the clinical efficacy of tramadol and morphine using a patient-controlled analgesia (PCA) delivery system.
Methods
In a prospective, randomized, double blind study, we evaluated 80 adult patients scheduled for elective hip or knee arthroplasty with general inhalational anesthesia. When patients complained of pain in the recovery room, patients were randomized to receive either tramadol or morphine by titration in 30 min to achieve analgesia (VAS ≤ 4). Equivalent volumes containing either 30 mg · ml−1 tramadol or 1 mg · ml−1 morphine were used for PCA with a lockout interval of 10 min. The patients were followed six-hourly for 48 hr for VAS, satisfaction rate, analgesic dose, and side effects.
Results
Patients obtained adequate analgesia with either drug. More patients had very good satisfaction scores in the morphine group in the recovery room (43% vs 23%,P < 0.05) and at 24 hr (40% vs 20%,P < 0.05) than those in the tramadol group. More nausea was evident in the tramadol group (48% vs 11% in recovery room and 28%vs 12% in 24 hr,P < 0.05) than in the morphine group. Vomiting was also more (28% vs 5% in recovery room, 15% vs 3% in 24 hr,P < 0.05). Morphine produced more sleepiness (45% vs 23% in recovery room,P < 0.05 and 35%vs 15% in 24 hr,P < 0.05).
Conclusion
Tramadol PCA can provide effective analgesia following major orthopedic surgery provided sufficiently high doses are given for loading and by patient demand. However, the incidence of nausea/vomiting is also higher causing decreased satisfaction.
Résumé
Objectif
Comparer l’efficacité clinique du tramadol et de la morphine en utilisant un système d’analgésie contrôlée par le patient (ACP).
Méthode
Lors d’une étude prospective, randomisée et en double aveugle, nous avons évalué 80 adultes dont l’arthroplastie de la hanche ou du genou avait été prévue avec une anesthésie générale d’inhalation. À la salle de réveil, les patients répartis au hasard ont reçu, quand ils éprouvaient de la douleur, du tramadol ou de la morphine selon un dosage permettant d’atteindre l’analgésie (EVA ≤ 4) en 30 min. Des volumes équivalents contenant 30 mg · ml−1 de tramadol ou 1 mg · ml−1 de morphine ont été utilisés pour l’ACP, qui comprenait une période réfractaire de 10 min. Les patients ont été revus à toutes les six heures pendant 48 h pour l’enregistrement des scores de l’EVA, de la satisfaction, de la dose d’analgésique et des effets secondaires.
Résultats
Les patients ont obtenu une analgésie suffisante avec l’un ou i’autre médicament. Un plus grand nombre de patients a été très satisfait dans le groupe ayant reçu de la morphine à la salle de réveil (43 % vs 23 %,P < 0,05) et à 24 h (40 % vs 20 %,P < 0,05) que ceux du groupe ayant reçu le tramadol. Il y a eu davantage de nausées dans le groupe du tramadol (48 % vs 11 % dans la salle de réveil et 28 % vs 12 % à pendant les 24 premières heures, P < 0,05) que dans le groupe de la morphine. Les vomissements ont été également plus fréquents (28 % vs 5 % en salle de réveil, 15 % vs 3 % pendant les 24 premières heures, P < 0,05). La morphine a produit plus de somnolence (45 % vs 23 % en salle de réveil,P < 0,05 et 35 % vs 15 % pendant 24 h,P < 0,05).
Conclusion
LACP avec le tramadol peut assurer une analgésie efficace à la suite d’une intervention orthopédique importante, pourvu que des doses suffisamment élevées soient administrées en dose d’attaque et à la demande du patient. Cependant, l’incidence de nausées et de vomissements est aussi plus élevée avec le tramadol, ce qui en diminue l’attrait.
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This study was carried out at the Department of Anesthesia, Show-Chwan Memorial Hospital, Changhua, Taiwan, R.O.C.
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Pang, WW., Mok, M.S., Lin, CH. et al. Comparison of patient-controlled analgesia (PCA) with tramadol or morphine. Can J Anesth 46, 1030–1035 (1999). https://doi.org/10.1007/BF03013197
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DOI: https://doi.org/10.1007/BF03013197