Gülçin AYDIN, Alparslan APAN, Emine Arzu KÖSE, Gökşen ÖZ

Pre-versus postoperative tramadol instillation: both are effective for decreasing pain and/or agitation in pediatric adenotonsillectomy

The present study aimed to investigate the possible influence of nasopharyngeal preoperative or postoperative tramadol instillation on postoperative pain and agitation in pediatric patients undergoing adenoidectomy, with or without tonsillectomy and tube placement. Materials and methods: Ninety pediatric patients were included in the study. Induction of anesthesia was achieved with 2.5 mg kg-1 propofol and 0.6 mg kg-1 rocuronium bromide. To maintain the anesthesia, 2%-2.5% sevoflurane in an oxygen-N2O mixture (FiO2 = 35%) was administered. In Group I (n = 30), 1 mg kg-1 tramadol was given 10 min before adenoidectomy, and in Group II (n = 30) it was administered 10 min after adenoidectomy was achieved on the adenoid tissue. Saline, at the same volume, was injected as a control in Group III (n = 30). Patients were evaluated for postoperative pain, agitation score, and modified Aldrete score (MAS) in recovery. Results: When compared with the treatment groups, pain scores and analgesic requirements in the control group significantly increased (P < 0.001). Agitation scores were also significantly higher in the same group. Time-related MASs were significantly lower in the control group in the early recovery period. Conclusion: Preoperative or postoperative tramadol instillation administered to the adenoidectomy area significantly decreased postoperative analgesic requirements and agitation.

Anahtar Kelimeler:

Key words: General anesthesia, sevoflurane, agitation, tramadol

Pre-versus postoperative tramadol instillation: both are effective for decreasing pain and/or agitation in pediatric adenotonsillectomy

Keywords:

Key words: General anesthesia, sevoflurane, agitation, tramadol,

PDF

___

Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology 1997; 87: 1298– 1300.
Cravero JP, Beach M, Thyr B, Whalen K. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg 2003; 97: 364–7.
Lee CR, McTavish D, Sorkin EM. Tramadol: a preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states. Drugs 1993; 46: 313–40.
Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Hosnuter M, Demirel CB, Babuccu O. The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic. Anesth Analg 2004; 99: 1461–4.
Ozköse Z, Akçabay M, Kemaloğlu YK, Sezenler S. Relief of posttonsillectomy pain with low-dose tramadol given at induction of anesthesia in children. Int J Pediatr Otorhinolaryngol 2000; 53: 207–14.
Ozalevli M, Unlügenç H, Tuncer Ü, Güneş Y, Özcengiz D. Comparison of morphine and tramadol by patient controlled analgesia for postoperative analgesia after tonsillectomy in children Pediatr Anesth 2005; 15: 979–84.
Engelhart T, Steel E, Johnston G, Veitch DY. Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine. Pediatr Anesth 2003; 13: 249–52.
Atef A, Fawaz AA. Peritonsillar infiltration with tramadol improves pediatric tonsillectomy pain. Eur Arch Otorhinolaryngol 2008; 265: 571–4.
Payne KA, Roelofse JA, Shipton EA. Pharmacokinetics of oral tramadol drops for postoperative pain relief in children aged 4 to 7 years: a pilot study. Anesth Prog 2002; 49: 109–12.
Payne KA, Roelofse JA. Tramadol drops in children: analgesic efficacy, lacks of respiratory effects, and normal recovery times. Anesth Prog 1999; 46: 91–6.
Aldrete JA. Kroulik D. Postanesthetic recovery score. Anesth Analg 1970; 49: 924–34.
Umuroğlu T, Eti Z, Çiftçi H, Göğüş FY. Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol. Pediatr Anesth 2004; 14; 568–73.
Akkaya T, Bedirli N, Ceylan T, Matkap E, Gulen G, Elverici O, Gumus H, Akin I. Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy. Eur J Anaesthesiol 2009; 26: 333–7.
Güneş Y, Gündüz M, Unlügenç H, Ozalevli M, Ozcengiz D. Comparison of caudal vs intravenous tramadol administered either preoperatively or postoperatively for pain relief in boys. Pediatr Anesth 2004; 14: 324–8.
Şahin Y, Apan A, Öz G, Evliyaoğlu ÇA. Epidural tramadol infiltration decreases postoperative analgesic consumption after microdiscectomy. Turk J Med Sci 2012; 42: 395–401.
Yurtlu BS, Hancı V, Ege A, Bostankolu SE, Ayoğlu H, Özkoçak Turan I. Tramadol as an adjunct for levobupivacaine in axillary plexus blockade: a prospective, randomized, double-blind study. Turk J Med Sci 2012; 42: 55–62.
Sansone RA, Sansone LA. Tramadol: seizures, serotonin syndrome and coadministered antidepressants. Psychiatry (Edgemont) 2009; 6: 17–21.