Comparison of Intravenous Paracetamol and Tramadol in Children Undergoing Major Abdominal Surgery

Year 2015, , 275 - 281, 28.09.2015

Aysu Değmez Mediha Türktan , Feride Karacaer Zehra Hatipoğlu Murat Gündüz

https://doi.org/10.17826/cutf.56616

Cited By: 1

Abstract

Purpose: Postoperative pain and pain related hemodynamic instability are frequently observed problems in children undergoing major abdominal surgery. In our study, we aimed to comparison of the effect intravenous paracetamol and tramadol on postoperative analgesia and tramadol consumption. Material and Methods: After approval of faculty ethical committee and parents consent, 90 children aged 3-14 years undergoing major abdominal surgery were included in this study. Patients randomly divided into two groups. Forty five minutes before the end of surgery, Group P patients were given intravenously paracetamol (15 mg/kg, in 15 minutes) and Group T patients were given intravenously tramadol(1 mg/kg). Parent controlled analgesia with tramadol (bolus dose 0.2 mg/kg, lock out 20 minutes) was started in both groups. Postoperatively, patients’ systolic and diastolic blood pressures, heart rates, oxygen saturation values, pain scores, total tramadol consumption and side effects were recorded. Results: Demographic data, duration of surgery and hemodynamic parameters were similar between the groups. Total tramadol consumption were recorded 76.11 ± 105.65 mg in Group P and 83.50 ± 97.35 mg in Group T for 24 hours(p>0.05). There was not any significantly difference in side effects and pain scores between the groups (p > 0.05). Conclusion: It was concluded that, intravenous paracetamol was provided effective analgesia but it was not superior to intravenous tramadol in children undergoing major abdominal surgery.

Keywords

Children, parent controlled analgesia, paracetamol, postoperative pain, tramadol

Major Abdominal Cerrahi Uygulanacak Çocuklarda İntravenöz Parasetamol ve İntravenöz Tramadolün Karşılaştırılması

Abstract

Amaç: Major abdominal cerrahi uygulanacak çocuklarda postoperatif ağrı ve buna bağlı hemodinamik instabilite sık karşılaşılan problemlerdir. Çalışmamızda intravenöz parasetamol ve tramadol uygulamasının postoperatif analjezi ve tramadol tüketimi üzerine etkilerini karşılaştırmayı amaçladık. Materyal ve Metod: Fakültemiz etik kurul onayı ve ebeveynlerinin yazılı onamları alındıktan sonra major abdominal cerrahi uygulanacak 3-14 yaş arası 90 çocuk çalışma kapsamına alındı. Hastalar rasgele iki gruba ayrıldı. Operasyon bitiminden 45 dakika once Grup P’ye intravenöz parasetamol (15 mg/kg, 15 dakika), Grup T’ye intravenöz tramadol (1 mg/kg) yapıldı. Her iki gruba da postoperatif ebeveyn kontrollü analjezi yöntemi ile tramadol infüzyonu (bolus doz 0.2 mg/kg, kilitli kalma süresi 20 dakika) başlandı. Postoperatif sistolik ve diyastolik arter basınçları, kalp hızı, oksijen satürasyon değerleri, ağrı skorları, toplam tramadol tüketimi ve yan etkiler kaydedildi. Araştırma Makalesi / Research Article 275 Aydoğan ve ark.. Cukurova Medical Journal Bulgular: Grupların demografik özellikleri, operasyon süreleri, hemodinamik parametreleri birbirine benzerdi. İlk 24 saatteki toplam tramadol tüketimi Grup P’de 76.11 ± 105.65 mg, Grup T’de 83.50 ± 97.35 mg olarak saptandı (p>0.05). Yan etkiler ve ağrı skorları açısından gruplar arasında anlamlı fark saptanmadı (p > 0.05). Sonuç: Major abdominal cerrahi geçiren çocuklarda uygulanan intravenöz parasetamolün etkin bir analjezi oluşturduğu ancak intravenöz tramadol uygulamasına üstün olmadığı kanısına varıldı.

Keywords

Çocuklar, ebeveyn kontrollü analjezi, parasetamol, postoperatif ağrı, tramadol

References

• Ferrante FM, Vadeboncoeur TR. Postoperative Pain Management. 2nd Ed., New York: Churchill Livingstone Inc. 1993:485-518.
• Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004;43:879-923.
• Scott LJ, Perry CM. Tramadol: a review of its use in perioperative pain. Drugs. 2000;60:139-76.
• Bonnefont J. Courade JP, Alloui A, Eschalier A. Mechanism of the antinociceptive effect of 15. Arana A, Morton NS, Hansen TG. Treatment with paracetamol. Drugs. 2003;63:1-4.
• Mitchell RWD, Smith G. The control of acute postoperative pain. Br J Anaesth. 1989;63:147-8.
• Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630- 41.
• Czarnecki ML, Hainsworth K, Simpson PM, Arca MJ, Uhing MR, Varadarajan J, et al Weisman SJ. Is there an alternative to continuous opioid infusion for neonatal pain control? A preliminary report of parent/nurse-controlled analgesia in the neonatal intensive care unit. Paediatr Anaesth. 2014;24:377- 85.
• Lehman KA. Tramadol for the management of acute pain .Drugs. 1994;47:19-32.
• Özyalçın S, Yücel A, Erdine S. Postoperatif
• analjezide tramadol, petidin, morfin ve fentanil ile iv PCA. Türk Anesteziyoloji ve Reanimasyon Mecmuası. 1997;25:207-13.
• Schug SA, Sidebotham DA, McGuinnety M. Acetaminophen as an adjunct to morphine by patient controlled analgesia in the management of actue postoperative pain. Anesth Analg. 1998;87:368-72.
• Kehlet H, Dahl JB. The value of 'multimodal' or 'balanced' analgesia in postoperative pain treatment. Anesth Analg. 1993;77:1048-56.
• Hernandez-Palazon J, Tortosa JA, Martínez- Lage JF, Perez-Florez D. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg. 2001;92:1473-6.
• Hynes D, McCarroll M, Hiesse-Provost O. Analgesic effectiveness and tolerability of repeated administrations of iv propacetamol hydrochloride and im diclofenac for the treatment of postopertive pain after total hip arthroplasty. Acta Anaesthesiol Scand. 2006;50:374-81.
• Kelley MT, Walson PD, Edge JH, Cox S, Mortensen ME. Pharmacokinetics and pharmacodynamics of ibuprofen isomers and acetaminophen in febrile children. Clin Pharmacol Ther. 1992;52:181-9 paracetamol in infants. Acta Anaesthesiol Scand. 2001;45:20-9.
• Autret E, Dutertre JP, Breteau M, Jonville AP, Furet Y, Laugier J. Pharmacokinetics of paracetamol in neonate and infant after administration of propacetamol chlorhydrate. Dev Pharmacol Ther. 1993;20:129-34.
• Prins SA, Van Dijk M, Van Leeuwen P, Searle S, Anderson BJ, Tibboel D, et al. Pharmacokinetics and analgesic effects of intravenous propacetamol vs rectal paracetamol in children after major craniofacial surgery. Paediatr Anaesth. 2008;18:582- 92.
• Anderson BJ, Woolard GA, Holford NH. Pharmacokinetics of rectal paracetamol after major surgery in children. Paediatr Anaesth. 1995;5:237- 42.
• Moller PL, Sindet-Pedersen S, Petersen CT, Juhl GI, Dillenschneider A, Skoglund LA. Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth. 2005;94:642-8.
• Morton NS, O’Brein K. Analgesic efficacy of parasetamol and diclofenac in children receiving PCA morphine. Br J Anaesth. 1999;82:715-17.
• Van der Marel CD, Peters JW, Bouwmeester NJ, Jacqz-Aigrain E, van den Anker JN, Tibboel D. Rectal acetaminophen does not reduce morphine consumption after major surgery in young infants. Br J Anaesth. 2007;98:372-9.
• Korpela R, Korvenoja P, Meretoja OA. Morphine- sparing effect of acetaminophen in pediatric day- case surgery. Anesthesiology. 1999;91:442-7.
• Aguirre Corcoles E, Duran Gonzalez ME, Zambudio GA, Gonzalez Celdran R, Castaño Collado I, Cárceles Barón MD, et al. [Post-surgical paediatric pain: Nursing- PCA vs continuous I.V. infusion of tramadol]. Cir Pediatr. 2003;16:30-3.
• Pendeville PE, Von Montigny S, Dort JP, Veyckemans F. Double-blind randomized study of tramadol vs. paracetamol in analgesia after day- case tonsillectomy in children. Eur J Anaesthesiol. 2000;17:576-82.
• Alhashemi JA, Daghistani MF. Effect of intraoperative intravenous acetaminophen vs. intramuscular meperidine on pain and discharge time after paediatric dental restoration.Eur J Anaesthesiol. 2007;24:128-33.
• Avellaneda C, Gómez A, Martos F, Rubio M, Sarmiento J, de la Cuesta FS. The effect of a single intravenous dose of metamizol 2 g, ketorolac 30 mg and propacetamol 1 gonhaedmodynamic parameters and postoperative pain after heart surgery. Eur J Anaesthesiol. 2000;17:85-90.