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Ala S, Pakzadeh P, Monajati M, Enayatifard R, Shiva A, Sahebnasagh A. Topical Formulation of Tramadol 5% in the Management of Osteoarthritis of the Knee: A Double-Blind, Randomized, Prospective, Placebo-Controlled Clinical Trial. J Pain Palliat Care Pharmacother 2024:1-9. [PMID: 39387573 DOI: 10.1080/15360288.2024.2384968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 06/07/2024] [Accepted: 07/20/2024] [Indexed: 10/15/2024]
Abstract
The goal of the present study was to evaluate the efficacy of topical tramadol in the management of knee osteoarthritis pain. Sixty patients with moderate to severe pain of knee osteoarthritis were enrolled. Patients were randomized to receive tramadol 5% or placebo along with oral diclofenac 100 mg/day. They were instructed to apply the ointment every 12 h on the knee for three weeks. To control breakthrough pain, the patients were allowed to take acetaminophen up to 650 mg per day. The measured variables were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS). Sixty patients completed the study. At the end of follow-up period, VAS decreased by 21% (from 7.2 ± 2.1 to 5.7 ± 2.4, p-value < 0.05) and WOMAC score decreased by 23% (from 49.6 ± 17.4 to 38.4 ± 18.1, p-value < 0.05) in intervention group. Topical tramadol was significantly effective in reducing the intensity of pain and osteoarthritis symptoms in comparison to placebo considering VAS (5.7 ± 2.4 vs. 8.0 ± 2.9, p-value = 0.001) and WOMAC score (38.4 ± 18.1 vs. 46.0 ± 18.6, p-value = 0.007). Topical tramadol 5% appears to be effective in moderate to severe knee osteoarthritis pain.
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Affiliation(s)
- Shahram Ala
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Parisa Pakzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
- Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahila Monajati
- Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Enayatifard
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Afshin Shiva
- Department of Clinical Pharmacy, Nephrology and Kidney Transplant Research Center, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, School of Medicine, Department of Internal Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Kang YJ, Cho JH, Hwang SH. The analgesic Efficacy and Safety of Topically Applied Tramadol in Peritonsillar Space During Pediatric Adenotonsillectomy: A Meta-Analysis. Ann Otol Rhinol Laryngol 2023; 132:1156-1167. [PMID: 36433693 DOI: 10.1177/00034894221136998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES To evaluate the efficacy of topically applied tramadol in peritonsillar area for pain control and induction of perioperative morbidity in children undergoing adenotonsillectomy. METHODS Two authors independently searched the databases (MEDLINE, SCOPUS, and Cochrane databases) up to April 2022 for randomized controlled trials comparing the efficacy of an intraoperative peritonsillar administered tramadol with placebo or other agents only in pediatric patients. The outcomes were postoperative pain scores, time to take the first pain reducing drugs, and postoperative nausea/vomiting. RESULTS Our analysis was based on 17 trials. Peritonsillar administered tramadol significantly reduced postoperative pain at less than 20 minutes (SMD -1.5852, 95% CI [-2.3900; -0.7804]), 1 hour (SMD -1.5811, 95% CI [-2.3400; -0.8222]), 8 hours (SMD -1.0258, 95% CI [-1.8792; -0.1724]), 16 hours (SMD -0.8397, 95% CI [-1.4266; -0.2529]), and 1 day (SMD -1.0110, 95% CI [-1.5213; -0.5007]) and the time to take the first analgesic drug (SMD 1.6565, 95% CI [0.2838; 3.0293]) compared with the placebo. However, tramadol showed no significant difference on postoperative pain relief effects and the time to take the first analgesic drug compared to the other topical agents (bupivacaine, lidocaine, ketamine, and dexamethasone). Tramadol did not cause significant postoperative nausea and vomiting. CONCLUSIONS This study demonstrated that intraoperatively applied topical tramadol could control postoperative pain and reduce the analgesic uptake compared with a control. However, the efficacy of tramadol in pain control was similar to other agents in pediatric adenotonsillectomy.
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Affiliation(s)
- Yun Jin Kang
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Nuhu SI, Atteh DF, Embu HY, Isamade ES, Kokong DD, Ma’an ND, Malau KT, Usman YM. Evaluation of the Effects of Peritonsillar Infiltration of Tramadol-Ketamine Combination Versus Tramadol Alone on Posttonsillectomy Pain in Children. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:84-90. [PMID: 37538215 PMCID: PMC10395861 DOI: 10.4103/jwas.jwas_31_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/03/2023] [Indexed: 08/05/2023]
Abstract
Introduction Tonsillectomy is associated with significant pain and post-operative pain control is often unsatisfactory. This study sought to evaluate the effect of peritonsillar infiltration of tramadol-ketamine combination, tramadol alone and ketamine alone on post-tonsillectomy pain in children. Patients and Methods A randomized double-blinded interventional study involving 90 patients aged 3-15 years of American society of anesthesiologists I or II physical status scheduled for elective adenoidectomy, tonsillectomy or adenotonsillectomy at JUTH was conducted. Patients were randomized into one of three groups: group I received tramadol 2mg/kg, group II received ketamine 1mg/kg plus tramadol 2mg/kg and group III received ketamine 1mg/kg only all made up to 2mls with normal saline and 1ml given per tonsillar bed. All patients had standard general anaesthesia with endotracheal intubation and monitoring. Data was analyzed using Epi-info version 7.1.5 with p £ 0.05. Result The analysis of data showed that the mean ages of the participants in group I, II and III were 5.70±2.00, 5.69±3.22 and 4.47±2.01 years respectively (p-value=0.091). Group II had significantly lower pain scores, longer time to first request of analgesia, earlier oral intake and discharge from the hospital compared to the group that received either tramadol or ketamine alone. Minimal side effects were noted across all the groups in the study. Conclusion Peri-tonsillar infiltration of tramadol-ketamine combination immediately after tonsillectomy (but before extubation of patients) significantly decreased post-tonsillectomy pain without increasing the incidence of side effects compared to tramadol or ketamine alone in children undergoing adenotonsillectomy.
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Affiliation(s)
- Samuel Isaiah Nuhu
- Department of Anaesthesia, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Henry Yammoh Embu
- Department of Anaesthesia, Jos University Teaching Hospital, Jos, Nigeria
| | | | | | - Nuhu Danle Ma’an
- Department of Ear, Nose and Throat, Jos University Teaching Hospital, Jos, Nigeria
| | - Kefas Thomas Malau
- Department of Anaesthesia, Jos University Teaching Hospital, Jos, Nigeria
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Shih MC, Long BD, Pecha PP, White DR, Liu YC, Brennan E, Nguyen MI, Clemmens CS. A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy. World J Otorhinolaryngol Head Neck Surg 2023; 9:9-26. [PMID: 37006744 PMCID: PMC10050970 DOI: 10.1002/wjo2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research. Data Sources PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley). Methods A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain-related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, timing of administration, and identities of the investigated drugs. Results One hundred and eighty-nine studies were included for analysis. Most studies included validated pain scales, with the majority using visual-assisted scales (49.21%). Fewer studies examined pain beyond 24 h postoperation (24.87%), and few studies included a validated sedation scale (12.17%). Studies have compared several different dimensions of pharmacologic treatment, including different drugs, timing of administration, modes of administration, and dosages. Only 23 (12.17%) studies examined medications administered postoperatively, and only 29 (15.34%) studies examined oral medications. Acetaminophen only had four self-comparisons. Conclusion Our work provides the first scoping review of pain and pediatric tonsillectomy. With drug safety profiles considered, the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain. The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta-analyses. Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively.
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Affiliation(s)
- Michael C. Shih
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Baylor College of MedicineHoustonTexasUSA
| | - Barry D. Long
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Department of Otolaryngology—Head and Neck SurgeryVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Phayvanh P. Pecha
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - David R. White
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Yi‐Chun C. Liu
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
- Department of Surgery ‐ Division of Pediatric OtolaryngologyTexas Children's HospitalHoustonTexasUSA
| | - Emily Brennan
- Department of Research and Education ServicesMedical University of South Carolina LibraryCharlestonSouth CarolinaUSA
| | - Mariam I. Nguyen
- Charleston County School of the ArtsNorth CharlestonSouth CarolinaUSA
| | - Clarice S. Clemmens
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
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Kim DH, Kim SW, Basurrah MA, Hwang SH. The efficacy and safety of peri-tonsillar administrated agents on pain treatment after pediatric tonsillectomy: A network meta-analysis. Int J Pediatr Otorhinolaryngol 2023; 165:111455. [PMID: 36696709 DOI: 10.1016/j.ijporl.2023.111455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We assessed the pain control efficacies and associated morbidities of drugs administered locally (around the tonsils) in pediatric patients undergoing a tonsillectomy. METHODS Randomized controlled trials up to April 2022 were retrieved from six databases. The treatment networks featured six interventions (ropivacaine, bupivacaine, levobupivacaine, ketamine, tramadol, and dexamethasone) and a control (placebo). The outcomes were the postoperative pain scores, the time to use of the first analgesic drugs, and postoperative nausea/vomiting. Both pairwise and network meta-analyses were performed. RESULTS All treatments controlled pain at 1 h and 1 day postoperatively. Although all agents tended to delay the time to the first analgesic drug, only bupivacaine, dexamethasone, ketamine, and tramadol significantly reduced the need for analgesics. No agent caused significant postoperative nausea or vomiting. The ranking hierarchy revealed that tramadol was superior in terms of pain control 1 h postoperatively, the time to the first analgesic drug, and the number of analgesic doses required; however, it ranked third in terms of operative time. CONCLUSION All drugs reduced postoperative pain. Tramadol was optimal in pain control, and dexamethasone also afforded good pain control with low incidences of nausea and vomiting.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Wang L, Guo Y, Tian J. The comparison of ketamine with tramadol for postoperative pain relief on children following adenotonsillectomy or tonsillectomy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e22541. [PMID: 33832058 PMCID: PMC8036051 DOI: 10.1097/md.0000000000022541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/03/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The comparison of ketamine with tramadol for pain control remains controversial in pediatric adenotonsillectomy or tonsillectomy. We conduct a systematic review and meta-analysis to explore the efficacy of ketamine vs tramadol for pain relief in children following adenotonsillectomy or tonsillectomy. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2019 for randomized controlled trials (RCTs) assessing the effect of ketamine vs tramadol for pediatric adenotonsillectomy or tonsillectomy. This meta-analysis is performed using the random-effects model. RESULTS Six RCTs are included in the meta-analysis. Overall, compared to ketamine group for pediatric adenotonsillectomy or tonsillectomy, tramadol is associated with substantially lower CHEOPS at 1 h (SMD = 1.56; 95% CI = 0.20-2.92; P = .02; low quality) and longer first time of additional pain medication (SMD = -0.47; 95% CI = -0.74 to -0.19; P = .0008; low quality), but demonstrates no obvious effect on CHEOPS at 6 h (SMD = 0.51; 95% CI = -1.17 to 2.19; P = .55; low quality), sedation scale at 1 h (SMD = -0.80; 95% CI = -3.07 to 1.48; P = .49; low quality) or additional pain medication (RR = 1.31; 95% CI = 0.85-2.02; P = .23; moderate quality). CONCLUSIONS Tramadol may be better to alleviate the postoperative pain after pediatric adenotonsillectomy or tonsillectomy.
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Affiliation(s)
| | | | - Jun Tian
- Department of Pediatrics, The First People's Hospital of Xiaoshan, Hangzhou, Zhejiang Province, P.R. China
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Analgesia for adenotonsillectomy in children: a comparison between peritonsillar infiltration of tramadol, ketamine, and placebo. Eur Arch Otorhinolaryngol 2020; 277:1815-1822. [PMID: 32157434 DOI: 10.1007/s00405-020-05878-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Post-tonsillectomy pain is mediated by nociceptive C-fibers located at peritonsillar space. Peritonsillar infiltration of medication could relieve post-operative pain blocking the afferent via. PURPOSE To evaluate the effect of peritonsillar infiltration of tramadol, ketamine, and placebo on post-operative pain in cases of adenotonsillectomy. METHODS This is a double-blind randomized placebo-controlled study. Children ASA I-II aged 3-13 years scheduled for adenotonsillectomy were included in the study. Patients were randomized to receive either 2 mg/kg of peritonsillar tramadol (Group T), 0.5 mg/kg of peritonsillar ketamine hydrochloride (Group K), and 3 mL of peritonsillar saline (Group P). Post-operative pain was recorded using the modified visual analogue scale at 2 h, 6 h, 12 h, and 24 h. Side effects, analgesia requirement, and first oral intake were also recorded. RESULTS There were included 112 patients and five were excluded until final evaluation. We evaluated 36 children of Group T, 36 of Group K, and 35 of Group P. Groups were similar regarding to age, weight, height, gender, tonsil and adenoid size, hemodynamic parameters during the surgery, surgery, and anesthesia time. There were no differences between the groups in relation to pain scores, analgesia requirement, or first time of oral intake (p > 0.05). Group T presented a higher incidence of vomit between 2 and 6 h after surgery (p > 0.05). CONCLUSION This study showed that peritonsillar infiltration of tramadol or ketamine were not superior to placebo in reducing post-operative pain in children undergone adenotonsillectomy. The use of tramadol increased the risk of nausea and vomit between 2 and 6 h after surgery.
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Tsaousi GG, Chatzistravou A, Papazisis G, Grosomanidis V, Kouvelas D, Pourzitaki C. Analgesic Efficacy and Safety of Local Infiltration of Tramadol in Pediatric Tonsillectomy Pain: A Systematic Review and Meta-Analysis. Pain Pract 2020; 20:550-563. [PMID: 32012446 DOI: 10.1111/papr.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to appraise clinical evidence of the impact of peritonsillar infiltration of tramadol, on postoperative pain control and the occurrence of adverse effects in children undergoing tonsillectomy. METHODS A database search was conducted to identify randomized controlled trials (RCTs) pertinent to peritonsillar infiltration of tramadol compared to no treatment (placebo) or other analgesic regimens. The outcomes of interest were postoperative pain intensity, time to first analgesic demand, rescue analgesic consumption up to 24 hours after intervention, and the occurrence of adverse events. RESULTS Twelve RCTs enrolling 972 pediatric patients were selected for qualitative analysis, among which eight were suitable for meta-analysis. Tramadol infiltration induced a significant reduction of pain intensity up to 24 hours post-tonsillectomy (mean difference [MD], -2.31; 95% confidence interval [CI], -3.49 to -1.12; P < 0.001; I2 = 97%) and time to first analgesic (MD 180.54; 95% CI, 56.91 to 304.18; P = 0.004; I2 = 99%), with no profound impact on postoperative nausea and vomiting (risk ratio [RR] 0.98; 95% CI, 0.73 to 1.32; P = 0.90; I2 = 0%) compared to the placebo group. The analgesic efficacy of tramadol infiltration was equivalent to the local or systematic use of ketamine or infiltration with local anesthetics. This effect was further enhanced when tramadol infiltration served as an adjunct to other analgesic interventions. No serious adverse events were reported. CONCLUSIONS In children undergoing tonsillectomy, peritonsillar infiltration of tramadol is associated with a postoperative analgesic benefit when compared to placebo, with negligible adverse events. Yet, no definite conclusion can be drawn due to the low quality, considerable heterogeneity, and paucity of the available data.
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Affiliation(s)
- Georgia G Tsaousi
- Department of Anesthesiology and ICU, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Chatzistravou
- Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Papazisis
- Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Grosomanidis
- Department of Anesthesiology and ICU, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chryssa Pourzitaki
- Department of Anesthesiology and ICU, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abdalla HB, Jain AK, Napimoga MH, Clemente-Napimoga JT, Gill HS. Microneedles Coated with Tramadol Exhibit Antinociceptive Effect in a Rat Model of Temporomandibular Hypernociception. J Pharmacol Exp Ther 2019; 370:834-842. [PMID: 30872390 DOI: 10.1124/jpet.119.256750] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Abstract
Coated microneedles have emerged as a promising drug delivery system for inflammatory pain treatment. We have previously shown that tramadol injection into the rat temporomandibular joint (TMJ) induces an antinociceptive and anti-inflammatory effect. In this study, microneedles coated with tramadol were investigated as a platform to treat TMJ pain. Male Wistar rats were administered tramadol using an intra-TMJ injection or with microneedles coated with tramadol, followed by 1.5% formalin nociceptive challenge administered 15 minutes later. The nociceptive behavior of rats was evaluated, and their periarticular tissues were removed after euthanasia for analysis. The duration of antinociceptive effect was determined by performing the formalin challenge at different time points extending up to 6 days post tramadol administration. Microneedles coated with tramadol produced an antinociceptive effect similar to injection of tramadol into the rat TMJ. Surprisingly, tramadol delivery using coated microneedles produced a more durable antinociceptive effect lasting as much as 2 days post tramadol delivery as compared with an antinociceptive effect lasting under 2 hours from intra-TMJ injection of tramadol. The proinflammatory cytokines tumor necrosis factor-α and interleukin-1β (IL-1β) were found to be reduced, whereas the anti-inflammatory cytokine IL-10 was found to be elevated in tramadol-treated groups. In conclusion, microneedles coated with tramadol can offer a therapeutic option for pain control of inflammatory disorders in the TMJ.
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Affiliation(s)
- Henrique Ballassini Abdalla
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil (H.B.A.); Department of Chemical Engineering, Texas Tech University, Lubbock, Texas (A.K.J., H.S.G.); and Faculdade São Leopoldo Mandic, Instituto e Centro de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil (M.H.N., J.T.C.-N.)
| | - Amit K Jain
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil (H.B.A.); Department of Chemical Engineering, Texas Tech University, Lubbock, Texas (A.K.J., H.S.G.); and Faculdade São Leopoldo Mandic, Instituto e Centro de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil (M.H.N., J.T.C.-N.)
| | - Marcelo Henrique Napimoga
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil (H.B.A.); Department of Chemical Engineering, Texas Tech University, Lubbock, Texas (A.K.J., H.S.G.); and Faculdade São Leopoldo Mandic, Instituto e Centro de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil (M.H.N., J.T.C.-N.)
| | - Juliana Trindade Clemente-Napimoga
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil (H.B.A.); Department of Chemical Engineering, Texas Tech University, Lubbock, Texas (A.K.J., H.S.G.); and Faculdade São Leopoldo Mandic, Instituto e Centro de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil (M.H.N., J.T.C.-N.)
| | - Harvinder Singh Gill
- Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil (H.B.A.); Department of Chemical Engineering, Texas Tech University, Lubbock, Texas (A.K.J., H.S.G.); and Faculdade São Leopoldo Mandic, Instituto e Centro de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil (M.H.N., J.T.C.-N.)
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Abstract
In modern times, all procedures in oral surgery need to be painless and management of postoperative pain needs to be adequate. The surgical extraction of the third molar or alveolectomy of the wisdom tooth is one of the most common surgical procedures carried out in oral surgery and it includes rising a flap, bone removal and suturing. These surgical procedures usually cause swelling, trismus and moderate to severe pain. Third molar surgery is often used as a model in clinical trials that are directed toward reducing postoperative pain and improving its management. Tramadol is a well-known central acting opioid analgesic that produces analgesia against multiple pain conditions such as postsurgical pain, obstetric pain, terminal cancer pain, pain of coronary origin and neuropathic pain. Tramadol is an atypical opioid. When administered locally, it has both analgesic and anesthetic properties. The aim of this paper was to present new findings on local effects of tramadol in oral surgery.
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Affiliation(s)
- Petar Đanić
- Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, Zagreb
| | - Ivan Salarić
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine University of Zagreb
| | - Darko Macan
- Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, Zagreb.,Department of Oral and Maxillofacial Surgery, School of Dental Medicine University of Zagreb
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Comparing the effects of peritonsillar infiltration of tramadol before and after the surgery on post-tonsillectomy pain. Eur Arch Otorhinolaryngol 2017; 274:2521-2527. [PMID: 28251321 DOI: 10.1007/s00405-017-4477-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
The aim of the study was to compare the effects of peritonsillar infiltration of tramadol before and after the surgery on post-tonsillectomy pain. In this double-blinded clinical trial study, 80 children aged 5-12 years old with ASA (American Society of Anesthesiologists) class I or II undergoing tonsillectomy involved. In group A (n = 40), after anesthesia induction and before starting the surgery, tramadol 2 mg/kg diluted in normal saline up to 2 cc total volume was injected into the tensile bed by the anesthesiologist using a 25 gauge needle. Surgery began 3 min later and the tonsils were removed using the sharp dissection method. In children of group B (n = 40), anesthesia induction was performed. When surgery was completed, tramadol 2 mg/kg diluted in normal saline up to 2 cc total volume was injected at the site of removing each tonsil using a 25 gauge needle by the anesthesiologist. Using the CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) Scale, pain recorded at different times. Patient sedation was recorded using the RAMSAY Sedation Scale. All the data were analyzed using SPSS 17 statistical software. Two groups significantly felt different pain intensities at different times following the surgery. At the three times, the mean sedation score in the group receiving tramadol infiltration before surgery was a little higher compared to the other group, but this difference was not significant (p > 0.05). As for the relative frequency of nausea and vomiting, the difference was not significant (p = 0.793). Request for analgesics between the groups was not significant (p = 0.556). The mean time of the first feeding after the surgery was not significant between the groups (p = 0.062). Surgical duration was almost the same for both groups (p > 0.05). Systolic blood pressures (before surgery, before extubation, and after extubation) were statistically the same in both groups (p < 0.05). Furthermore, systolic blood pressures 10, 15, and 30 min after entry into the recovery room were the same in both groups. We concluded that peritonsillar infiltration of tramadol before surgery controlled postoperative pain better from 8 h after the surgery to hospital discharge (late effect), but that local infiltration of tramadol after surgery controlled postoperative pain better up to 2 h after the operation (early effect).
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Comparison of different administration of ketamine and intravenous tramadol hydrochloride for postoperative pain relief and sedation after pediatric tonsillectomy. J Craniofac Surg 2015; 26:e21-4. [PMID: 25569408 DOI: 10.1097/scs.0000000000001250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Tonsillectomy is the oldest and most frequently performed surgical procedure practiced by ear, nose, and throat physicians. In this study, our aim was to compare the analgesic effects of peritonsillar, rectal, as well as intravenous infiltration of ketamine and intravenous tramadol hydrochloride infiltration for postoperative pain relief and sedation after tonsillectomy in children. MATERIALS AND METHODS This randomized controlled study evaluated the effects of peritonsillar, intravenous, and rectal infiltration of ketamine in children undergoing adenotonsillectomy. One hundred twenty children who were categorized under American Society of Anesthesiologists classes I to II were randomized to 4 groups of 30 members each. Group 1 received intravenous (IV) ketamine (0.5 mg/kg), group 2 received rectal ketamine (0.5 mg/kg), group 3 received local peritonsillar ketamine (2 mg/kg), and the control group received IV tramadol hydrochloride infiltration (2 mg/kg). Children's Hospital of Eastern Ontario Pain Scale scores and Wilson sedation scale were recorded at minutes 1, 15, 30, 60 as well as hours 2, 12, and 24 postoperatively. The patients were interviewed on the day after the surgery to assess the postoperative pain and sedation. RESULTS All the routes of infiltration of ketamine were as effective as those of tramadol hydrochloride (P > 0.05). A statistically significant difference was observed between IV infiltrations and all groups during the assessments at hours 6 and 24. The analgesic efficacy of IV ketamine was found especially higher at hours 6 and 24 (P(6) = 0.045, P(24) = 0.011). CONCLUSIONS Perioperative, low-dose IV, rectal, or peritonsillar ketamine infiltration provides efficient pain relief without any adverse effects in children who would undergo adenotonsillectomy.
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Gönül O, Satılmış T, Bayram F, Göçmen G, Sipahi A, Göker K. Effect of submucosal application of tramadol on postoperative pain after third molar surgery. Head Face Med 2015; 11:35. [PMID: 26467984 PMCID: PMC4606474 DOI: 10.1186/s13005-015-0090-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
The aim of this study was to evaluate the effectiveness of submucosal application of tramadol, for acute postoperative facial pain, following the extraction of impacted third molar teeth. This prospective, double-blind, randomised placebo-controlled study included 60 ASA I-II patients undergoing impacted third molar surgery under local anaesthesia. Following the surgical procedure, patients were randomly divided into two groups; group T (1 mg/kg tramadol) and group S (2-mL saline). Treatments were applied submucosally after surgery. Pain after extraction was evaluated using a visual analogue scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 h postoperatively. The time at which the first analgesic drug was taken, the total analgesic dose used, and adverse tissue reactions were also evaluated. In group T, postoperative VAS scores were significantly lower compared to that in group S (p < 0.05). This study demonstrated that post-operative submucosal application of tramadol is an effective method for reducing acute post-operative facial pain after impacted third molar surgery.
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Affiliation(s)
- Onur Gönül
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
| | - Tülin Satılmış
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Ferit Bayram
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Gökhan Göçmen
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Aysegül Sipahi
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Kamil Göker
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Retrospective Evaluation on the Analgesic Activities of 2 Compounded Topical Creams and Voltaren Gel in Chronic Noncancer Pain. Am J Ther 2015; 22:342-9. [DOI: 10.1097/mjt.0000000000000275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Honarmand A, Safavi M, Naghibi K, Attari M, Soltani M, Amoushahi M, Sadeghipanah F. Preemptive peritonsillar infiltration with bupivacaine in combination with tramadol improves pediatric post-tonsillectomy pain better than using bupivacaine or tramadol alone: A randomized, placebo-controlled, double blind clinical trial. Adv Biomed Res 2015; 4:132. [PMID: 26322280 PMCID: PMC4544119 DOI: 10.4103/2277-9175.161518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background: Post-tonsillectomy pain is one of the most common problems after anesthesia, therefore use of a good anesthesia technique with minimum side effect is an important aim. This study was performed to compare the efficacy of peritonsillar infiltration of bupivacaine, tramadol and combination of bupivacaine-tramadol in post-tonsillectomy pain. Materials and Methods: In a double blind trial 120 ASA I and II children condidated for tonsillectomy were randomized into four groups: Peritonsillar infiltration with bupivacaine 1 mg/kg in Group B, tramadol 2 mg/kg in Group T, combination of bupivacaine-tramadol in Group BT and saline in Group C was done. Results: Until 60 minutes in the recovery room, control of pain in the first three groups were better than Group C (P < 0.05) and in the third group it was better than others. Four hours after surgery, control of pain was better in the second and third groups in comparison to Groups B and Group C (P <0.05) and was better in the third group in comparison to the second group. Then, 24 hours after that, only in the group III the control of pain was effective (P < 0.05). Conclusions: In this study we showed that peritonsillar infiltration with combination of bupivacain-tramadol provided less post surgery pain compared with infiltration of bupivacaine and tramadol alone in adenotonsillectomy of children.
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Affiliation(s)
- Azim Honarmand
- Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Safavi
- Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khosrou Naghibi
- Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadali Attari
- Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Soltani
- Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Amoushahi
- Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Sadeghipanah
- Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Hadi BA, Sbeitan SM. Clinical pharmacy intervention post tonsillectomy: a randomized control trial. Int J Clin Pharm 2015; 37:133-8. [PMID: 25564179 DOI: 10.1007/s11096-014-0051-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 12/05/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pain control in pediatric patients undergoing tonsillectomy remains a dilemma. Tramadol and ketamine are reported to be an effective analgesic. AIM OF THE STUDY To evaluate the effect of peritonsillar infiltration of tramadol in combination with ketamine versus peritonsillar infiltration of tramadol posttonsillectomy. SETTING Specialty hospital in Jordan. METHOD Sixty children, aged 7-12 years, selected for tonsillectomy were enrolled in the study. We divided the patients into two groups 30 of each, Group I: received peritonsillar saline and peritonsillar infiltration of tramadol 2 mg/kg, Group II: received peritonsillar infiltration of ketamine 1.0 mg/kg added to peritonsillar tramadol 2 mg/kg. MAIN OUTCOME MEASURE Hemodynamic stability, pain scale, first request of analgesia, total analgesics consumption and post-operative nausea and vomiting (PONV) side effects were recorded 24 h after surgery. RESULTS The analysis of data showed that Group II had significantly lower face pain scale, longer time for first request of analgesia, and better hemodynamic stability than GI (p < 0.001). On the other hand the total analgesics requirements, time of surgery, and PONV showed no significant differences between the two groups. CONCLUSION Combined use of peritonsillar infiltration of ketamine 1.0 mg/kg with tramadol 2 mg/kg provided prolong analgesic effects, less pain with no side effect, and better hemodynamic stability compared with using tramadol alone in patients undergoing tonsillectomy.
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Affiliation(s)
- Bushra Abdul Hadi
- Faculty of Pharmacy, Philadelphia University, P.O. Box 1, Amman, 19392, Jordan,
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Tong Y, Ding XB, Wang X, Ren H, Chen ZX, Li Q. Ketamine peritonsillar infiltration during tonsillectomy in pediatric patients: An updated meta-analysis. Int J Pediatr Otorhinolaryngol 2014; 78:1735-41. [PMID: 25139134 DOI: 10.1016/j.ijporl.2014.07.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/20/2014] [Accepted: 07/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Peri-operative ketamine peritonsillar infiltration in children can reduce the incidence of postoperative nausea and vomiting (PONV), but its postoperative analgesic time is short. A previous meta-analysis in 2011 was inconclusive due to insufficient data. Consequently, we updated the meta-analysis to verify the role of ketamine peritonsillar infiltration for tonsillectomy in pediatric patients. METHODS Ten randomized controlled trials with a total of 522 cases were included. Pain intensity was measured by standard modified CHEOPS score. RESULTS The pain scores of ketamine group at 30 min and 60 min were significantly lower than placebo group after surgery [weighted mean difference (WMD) -1.20, 95% CI -2.20 to -0.19, P=0.02; WMD -1.71, 95% CI -2.12 to -0.22, P=0.02]. Analgesic requirement in ketamine group were less than placebo group [risk ratio (RR) 0.51, 95% CI 0.26-0.97; P=0.04]. Moreover, the incidence of PONV was lower in ketamine group. (RR 0.73, 95% CI 0.54-0.97; P=0.03). However, there were no differences between these two groups in operation time, anesthesia time, first analgesic time and pain score at 120 min. CONCLUSIONS Compared to placebo, ketamine peritonsillar infiltration can relieve postoperative pain within one hour but not at 120 min and reduces analgesic requirement and incidence of PONV. Moreover, there was no difference in the first analgesic time.
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Affiliation(s)
- Yao Tong
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Xi-Bing Ding
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Xin Wang
- Department of First Clinical Medical College, Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Hao Ren
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Zhi-Xia Chen
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Quan Li
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
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Tugrul S, Degirmenci N, Eren SB, Dogan R, Veyseller B, Ozturan O. Analgesic effect of magnesium in post-tonsillectomy patients: a prospective randomised clinical trial. Eur Arch Otorhinolaryngol 2014; 272:2483-7. [PMID: 25097030 DOI: 10.1007/s00405-014-3219-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to assess the analgesic, bleeding and nausea/vomiting effects of magnesium with and without metamizol on post-tonsillectomy patients. This prospective and randomised clinical trial included 54 patients aged 18-63 years who were scheduled for elective tonsillectomy. The patients were randomly divided into two groups and administered either magnesium with metamizol or only metamizol. They had been classified as physical status class I and II using the American Society of Anesthesiologists guidelines. All patients underwent the same surgical procedure performed by a single surgeon. The groups did not differ according to age, sex, or duration of anaesthesia or surgery. Postoperative pain, bleeding and nausea/vomiting were evaluated using the VAS and bleeding and nausea/vomiting scores on the first, fifth and tenth days. On the first, fifth and tenth postoperative days, the VAS scores of the magnesium with metamizol group were significantly lower than those of the metamizol-only group (p1 = 0.001; p5 = 0.015; p10 = 0.015). There were no significant differences in postoperative bleeding and nausea/vomiting scores between the two groups (p = 0.425 and p = 0.258, respectively). This study showed that magnesium enhanced the analgesic effect on post-tonsillectomy pain. Use of magnesium with an analgesic drug may be beneficial for management of post-tonsillectomy pain.
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Affiliation(s)
- S Tugrul
- Medical Faculty, Department of Otorhinolaryngology and Head and Neck Surgery, Bezmialem Vakif University, Istanbul, Turkey,
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Vons KMJ, Bijker JB, Verwijs EW, Majoor MHJM, de Graaff JC. Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children. Paediatr Anaesth 2014; 24:476-82. [PMID: 24646093 DOI: 10.1111/pan.12383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting. METHODS A prospective cohort study was performed including 167 children aged 0-12 years, undergoing AD using an adenotome and ATE using the guillotine technique in day care. Children undergoing AD received acetaminophen pre- and postoperatively. Children undergoing ATE received acetaminophen and diclofenac preoperatively, sufentanyl postoperative and a prescription of around-the-clock treatment with acetaminophen and diclofenac at home. Pain intensity and analgesic consumption were recorded in hospital using the Faces, Legs, Activity, Cry and Consolability-scale (FLACC), as well as during a 1-week follow-up period at home using the Parents' Postoperative Pain Measure (PPPM) and Visual Analogue Scale (VAS) scores. RESULTS All children left the recovery room with adequate pain scores and were discharged with a median VAS of two after ATE and one after AD. The PPPM and VAS scores were highest at the first measurement at home for AD patients (VAS = 2.0 and PPPM = 1.5) and ATE patients (VAS = 4.5 and PPPM = 9). On the second postoperative day, AD patients scored 0.0 points on both VAS and PPPM. ATE patients scored at that time 3.0 point on the VAS and 6.0 points using the PPPM. Despite high adherence to pain treatment, daytime activities normalized after an average of 2 and 7 days after AD and ATE, respectively. CONCLUSION Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.
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Affiliation(s)
- Kristy M J Vons
- Department of Anesthesia, Gelderse Vallei Hospital, Ede, The Netherlands
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Abdelhalim AA, Al Harethy S, Moustafa M. Lornoxicam versus tramadol for post-operative pain relief in patients undergoing ENT procedures. Saudi J Anaesth 2014; 8:38-44. [PMID: 24665238 PMCID: PMC3950450 DOI: 10.4103/1658-354x.125935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Pain following ear-nose and throat surgery is one of the most important complaints for which, several drugs are used. This prospective, randomized, double-blind controlled trial was designed to compare the analgesic effect of tramadol versus lornoxicam for post-operative pain relief in patients undergoing ENT surgical procedures. Methods: One hundred and twenty patients of ASA class I-II, who had undergone elective ENT surgical procedures under general anesthesia, were assigned in a randomized manner into three equal groups. Group L received lornoxicam8 mg IV, Group T received tramadol 1 mg/kg IV and Group C received IV saline after induction of anesthesia before the start of the surgery. Post-operative pain was assessed using the visual analogue scale (VAS) and sedation level was evaluated during stay in the post-anesthesia care unit with a four-point sedation scale. Intraoperative blood loss was estimated using the Five-Point Scale. Adverse events in the first 24 h post-operative were recorded. Results: The VAS pain scores were significantly higher in Group C as compared with those in Groups L and T at 30 min and 1, 2, 4and 6 h post-operatively, with no significant difference between Group L and Group T. The amount of morphine consumption post-operatively was significantly lower in Group L (5.2 ± 2.5 mg) and Group T (5.0 ± 2.0 mg) as compared with that in Group C (7.4 ± 2.3 mg) (P = 0.001). The time for the first analgesic requirement was significantly less in Group L (92.62 ± 24.23 min) and Group T (88 ± 21.43 min) as compared with that in Group C (42.82 ± 25.61 min), with no significant difference between the other two groups. Estimated intraoperative blood loss score by the surgeons showed no significant difference between the three groups. The most frequent side-effects in the three groups were nausea and vomiting, and their incidence was significantly higher in the placebo group as compared with the other two groups. Conclusion: Tramadol 1 mg/kg was comparable to lornoxicam 8 mg for post-operative pain relief in patients undergoing ENT surgical procedures; both drugs helped to reduce the post-operative opioid requirement and consequently minimized the related adverse effects of the opioids.
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Affiliation(s)
- Ashraf A Abdelhalim
- Department of Anesthesiology, Alexandria University, Egypt and King Saud University, Riyadh, Saudi Arabia
| | - Sami Al Harethy
- Department of ENT, King Abdul Aziz University Hospital, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Moustafa
- Department of Anesthesiology, Assiut University, Egypt, Consultant, King Saud University, Riyadh, Saudi Arabia
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The comparison of preincisional peritonsillar infiltration of ketamine and tramadol for postoperative pain relief on children following adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2013; 77:1825-9. [PMID: 24041860 DOI: 10.1016/j.ijporl.2013.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate and compare the effectiveness of preincisional peritonsillar infiltration of ketamine and tramadol for post-operative pain on children following adenotonsillectomy. STUDY DESIGN Prospective randomized double blind controlled study. METHODS Seventy-five children aged 3-10 years undergoing adenotonsillectomy were included in study. Patients received injections in peritonsillar fossa of tramadol (2 mg/kg-2 ml), ketamine (0.5 mg/kg-2 ml) or 2 ml serum physiologic. During operation heart rate, oxygen saturation, average mean blood pressures were recorded in every 5 min. Operation, anesthesia and the time that Alderete scores 9-10, patient satisfaction, analgesic requirements were recorded. Postoperatively nausea, vomiting, sedation, dysphagia, bleeding scores were recorded at 0, 10, 30, 60 min and 2, 4, 8, 12, 18, 24h postoperatively. Pain was evaluated using modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at fixed intervals after the procedure (15 min and 1, 4, 12, 16, and 24h postoperatively). RESULTS The recordings of heart rate, mean arterial pressure, nausea, vomiting, sedation and bleeding scores were similar in all groups (p>0.05). The mCHEOPS scores at 10 min, 30 min, 1h, 8h were significantly lower in both tramadol and ketamine group when compared with control (p<0.05). Use of additional analgesia at 10 min and 18 h were higher in control group than ketamine, tramadol group (p<0.05). Dysphagia scores were significantly lower for both ketamine and tramadol group when compared with control group (p<0.05). mCHEOPS, additional analgesia, dysphagia, patient satisfaction scores were similar in tramadol, ketamine groups (p>0.05). CONCLUSIONS Preincisional injection of ketamine and tramadol prior to tonsillectomy is safe, effective method and equivalent for post-tonsillectomy pain, patient satisfaction, postoperative nausea, vomiting, dysphagia.
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Tekelioglu UY, Apuhan T, Akkaya A, Demirhan A, Yildiz I, Simsek T, Gok U, Kocoglu H. Comparison of topical tramadol and ketamine in pain treatment after tonsillectomy. Paediatr Anaesth 2013; 23:496-501. [PMID: 23521170 DOI: 10.1111/pan.12148] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 01/05/2013] [Accepted: 02/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES/AIM The primary objective of this study is to evaluate the effects of topically applied ketamine or tramadol on early postoperative pain scores in children undergoing tonsillectomy. The secondary aim of the study is to assess nausea, vomiting, difficulty in swallowing, and sore throat characteristics of the patients. BACKGROUND Tonsillectomy surgery is frequently associated with postoperative pain, which usually requires substantial consumption of analgesics including opioids. Safe and effective post-tonsillectomy pain control is still a clinical dilemma, in spite of the use of various surgical and anesthetic techniques. METHODS A total of 60 children, aged between 4 and 10 years, scheduled for tonsillectomy, were randomly assigned to one of three groups. Study drugs were administered to both tonsillar fossae for 5 min. In 5 ml artificial saliva, Group K (n = 20) received 0.4 ml (20 mg) ketamine and Group T (n = 20) received 0.8 ml tramadol HCl solution. Group C (n = 20) received only 5 ml saline as a control. Ramsay Sedation Scale and FACES PRS Score, nausea, vomiting, difficulty in swallowing, and sore throat were evaluated. RESULTS There was no difference among the groups in terms of baseline characteristics, including age, sex, and ASA profile (P > 0.05 for all). Systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, respiratory rate, and saturation of peripheral oxygen (SpO2 ) values were not significantly different among the groups in all time points (P > 0.05 for all). There was a statistically significant difference among the groups according to Ramsay Sedation Scales in 40th minute (P < 0.001). There were statistically significant differences among the groups in terms of Wong-Baker FACES Pain Rating Scale Score in all time points (P < 0.004 for all). There was a statistically significant difference among the groups in terms of rescue analgesia necessity in 5th and 10th minute (P < 0.001 and P = 0.003). There was a statistically significant difference among the groups in terms of sore throat in 5th and 10th minute (P < 0.001 for both). Neither rescue analgesia necessity nor sore throat characteristics was different between the Group T and Group K in all time points. CONCLUSION Topical tramadol and ketamine seem to be safe, effective, and easy analgesic approach for decreasing tonsillectomy pain.
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Affiliation(s)
- Umit Y Tekelioglu
- Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey.
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Koputan MH, Apan A, Oz G, Köse EA. The effects of tramadol and levobupivacaine infiltration on postoperative analgesia in functional endoscopic sinus surgery and septorhinoplasty. Balkan Med J 2012; 29:391-4. [PMID: 25207040 DOI: 10.5152/balkanmedj.2012.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 03/22/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this prospective, randomized, double-blind study was to investigate the postoperative analgesic effects of levobupivacaine or tramadol infiltration administered prior to surgery in septorhinoplasty (SRP) or endoscopic sinus surgery (ESS). MATERIAL AND METHODS Sixty ASA class I-III adult patients electively undergoing SRP or ESC were included the study. Induction of anesthesia was performed with propofol 2-2.5 mg/kg, rocuronium bromide 0.6 mg/kg and fentanyl 1 μg/kg i.v. Sevoflurane 2% with an N2O/O2 mixture (FiO2: 35%) was used for maintenance. Tramadol 0.5 mg/kg (Group T: n=20), levobupivacaine 0.25% (Group L: n=20) and lidocaine 1% (Group C: n=20) in a 1/200,000 adrenaline solution was infiltrated into the surgical area 10 min before the operation (5 mL for ESS and 10 mL for SRP). All patients received fentanyl (bolus dose: 15 μg and lockout interval: 10 min) with a patient-controlled analgesia device during the postoperative period. Pain was assessed using an 11-point visual analogue scale (VAS) every 4 h for the first 24 h. Analgesic requirements, opioid consumption and side effects in the postoperative period were recorded. RESULTS There was a statistically significant decrease in postoperative fentanyl demand and consumption in patients receiving tramadol. Fentanyl doses in the 24 h period were 345.2±168.8 μg, 221.1±120.6 μg and 184.1±130.3 μg (p=0.002) for the Groups C, L and T, respectively. There were statistically significant differences in fentanyl requirements between the tramadol and control groups at the 16, 20 and 24 h time points (p=0.012, p=0.004 and p=0.002, respectively). The side effect profiles were similar. CONCLUSIONS Our study indicates that the preemptive tramadol infiltration technique is an efficient, practical and safe alternative to levobupivacaine in ESS or SRP operations.
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Affiliation(s)
- Muhammet Hilmi Koputan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Alparslan Apan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Gökşen Oz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Emine Arzu Köse
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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Ayatollahi V, Behdad S, Hatami M, Moshtaghiun H, Baghianimoghadam B. Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial. Croat Med J 2012; 53:155-61. [PMID: 22522994 PMCID: PMC3342650 DOI: 10.3325/cmj.2012.53.155] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. Methods The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. Results Tramadol group had significantly lower pain scores (P = 0.005), significantly longer time to the first request for analgesic (P = 0.001), significantly shorter time to the beginning of liquid regimen (P = 0.001), and lower hemodynamic parameters such as blood pressure (P = 0.001) and heart rate (P = 0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. Conclusion Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects. Registration No: IRCT201103255764N2
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Affiliation(s)
- Vida Ayatollahi
- Department of Anesthesiology, Shahid Sadoughi Hospital, Bou ali BLVD, 8916886938 Yazd, Iran
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Comparison of peritonsillar infiltration of tramadol and lidocaine for the relief of post-tonsillectomy pain. The Journal of Laryngology & Otology 2012; 126:1138-41. [PMID: 22989763 DOI: 10.1017/s0022215112002058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Several studies have reported the use of peritonsillar infiltrations of local anaesthetics and/or locally active analgesic drugs for the relief of post-tonsillectomy pain, with variable results in terms of quality and duration of analgesia. We aimed to compare the effects of peritonsillar infiltration of lidocaine versus tramadol versus placebo on post-tonsillectomy pain. METHODS Sixty patients over the age of 10 years undergoing bilateral elective tonsillectomy under general anaesthesia were randomised into three groups. The first group received peritonsillar infiltration of tramadol, the second 2 per cent lidocaine and the third normal saline. In all groups, peritonsillar infiltration was carried out after tonsillectomy but prior to tracheal extubation. Post-operative comparisons were made to assess the quality of pain control and the patients' analgesic requirements. RESULTS Peritonsillar infiltration of tramadol provided an analgesic effect comparable to that of lidocaine in the first 6 hours post-operation, as reflected by visual analogue scale pain scores and opioid requirements, which were lower compared with the placebo group. CONCLUSION Peritonsillar infiltration of tramadol provided pain control in the first 6 hours post-tonsillectomy which was comparable to that of lidocaine.
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Ekmekçi P, Beriat GK, Bengisun ZK, Kazbek BK, Duman P, Süer H. The efficacy of submucosal tramadol in the postoperative treatment of pain following septoplasty operations. Indian J Otolaryngol Head Neck Surg 2012; 65:12-5. [PMID: 24381911 DOI: 10.1007/s12070-012-0571-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/24/2012] [Indexed: 11/24/2022] Open
Abstract
Tramadol is a centrally acting opioid which is effective for moderate-severe pain and is being used for various acute and chronic pain scenarios. The primary endpoint of this controlled, randomized double blind study was to evaluate the effect of submucosal tramadol on VAS scores after septoplasty operations and secondary endpoint was to investigate the effects on total opioid and additional analgesic consumption and patient satisfaction. 60 patients scheduled for septoplasty under general anaesthesia were enrolled. In Group T, at the end of surgery following hemostasis, 2 mg/kg tramadol was applied as submucosal infiltration to both surgical sites, 2 ml (total 4 ml), by the surgeon. In Group P, at the end of surgery following hemostasis, 2 ml isotonic solution (total 4 ml) was applied as submucosal infiltration to both surgical sites by the surgeon. Total opioid consumption, VAS scores, patient satisfaction was evaluated at the end of 24 h VAS values were higher in Group P on the first and second postoperative hours. Patient controlled analgesia demand and delivery values were higher in Group P on the postoperative 1, 2, 4, 6, 12 and 24th hours. Patient satisfaction was higher and opioid consumption was lower in Group T compared to Group P. There was no difference in additional analgesic consumption between two groups. The results show that patients receiving tramadol had lower VAS scores compared with the placebo groups postoperatively.
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Affiliation(s)
- Perihan Ekmekçi
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Güçlü Kaan Beriat
- Department of Ear, Nose and Throat, Ufuk University Dr Rıdvan Ege Hospital, Ankara, Turkey
| | - Züleyha Kazak Bengisun
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Baturay Kansu Kazbek
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Peyami Duman
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Hikmet Süer
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
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Pestieau SR, Quezado ZMN, Johnson YJ, Anderson JL, Cheng YI, McCarter RJ, Choi S, Finkel JC. High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children. Can J Anaesth 2011; 58:540-50. [DOI: 10.1007/s12630-011-9493-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022] Open
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Akbay BK, Yildizbas S, Guclu E, Yilmaz S, Iskender A, Ozturk O. Analgesic efficacy of topical tramadol in the control of postoperative pain in children after tonsillectomy. J Anesth 2010; 24:705-8. [PMID: 20563735 DOI: 10.1007/s00540-010-0978-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 05/31/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Pain control after tonsillectomy is still a controversial issue. Topical approaches have the advantage of pain control with good patient acceptability. Therefore, this study was conducted to evaluate the effects of topical tramadol on postoperative pain and morbidity in children undergoing tonsillectomy. METHODS A prospective, randomized, double-blind, controlled clinical study was designed. Forty children aged between 4 and 15 years, ASA I-II, scheduled for elective tonsillectomy and/or adenoidectomy were randomized into two groups. For patients in Group T (n = 20) swabs soaked with 2 mg/kg tramadol diluted in 10 ml saline were applied to both of their tonsillar fossa for 5 min; in the control group (n = 20) swabs soaked with 10 ml saline were applied. Postoperative pain scores, bleeding, nausea, vomiting, abdominal discomfort, constipation, pain in the throat, painful swallowing, fever, otalgia, trismus, and halitosis were recorded at the first, fifth, thirteenth, seventeenth, twenty-first, and twenty-fourth postoperative hours and the week after tonsillectomy. RESULTS Pain scores were found to be significantly lower at the 21st hour and on postoperative day seven in the tramadol group compared with the control group (p < 0.05). Mean daily pain scores ranged from Day 1: 0.34 (±0.21) to Day 7: 0.11 (±0.08) in the tramadol group and Day 1: 0.53 (±0.14) to Day 7: 0.42 (±0.15) in the control group. There were no significant differences in morbidity between the groups (p > 0.05). CONCLUSION Topical 5% tramadol with its local anesthetic effect seems to be an easy, safe, and comfortable approach for pain management in children undergoing tonsillectomy.
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Affiliation(s)
- Buket Kocaman Akbay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Duzce University, Duzce, Turkey.
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Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy. Eur J Anaesthesiol 2009; 26:333-7. [PMID: 19401664 DOI: 10.1097/eja.0b013e32831c8988] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to compare the postoperative analgesic efficacy and side-effects of intravenous tramadol with peritonsillar infiltration of tramadol in children undergoing adenotonsillectomy. METHODS Sixty-six children were randomized into two groups: group I received 2 mg kg(-1) tramadol intravenously and group II received 2 mg kg(-1) tramadol in 2 ml of normal saline (1 ml per tonsil) via peritonsillar infiltration. Modified Hannallah pain scale, nausea, vomiting, bleeding, rescue analgesia, sedation and Aldrete scores were recorded at the 1st, 15th, 30th and 60th minute postoperatively. The Aldrete score was used to determine the postanaesthesia care unit discharge criteria. Patients were evaluated for the analgesic requirement, nausea and vomiting, bleeding and sedation. RESULTS There were no differences between groups during the first 1 h. In the postanaesthesia care unit, groups I and II had comparable pain scores that were not statistically significant (P > 0.05). But during the first 24 h the additional analgesic requirement of group I (141.81 mg) was more than group II (83.63 mg) (P = 0.002). Pain scores in the postoperative ward at 6, 12 and 24 h were significantly higher in group I than in group II (P < 0.001). Also four patients (12.12%) from group I and one patient (3.05%) from group II had nausea and vomiting in the postanaesthesia care unit and none of the patients had rescue analgesics. There were no differences between groups regarding nausea and vomiting, sedation and bleeding in the postoperative ward. CONCLUSION In adenotonsillectomy cases, peritonsillar infiltration of tramadol maintains efficient pain relief with lower incidence of nausea and vomiting.
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