A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children

Demiraran, Yavuz; Kocaman, Buket; Akman, Ramazan Yavuz

doi:10.1093/bja/aei214

Cited by 35 publications

(34 citation statements)

References 26 publications

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“…Furthermore Demiraran et al . [17] in their study on the use of single dose epidural morphine versus tramadol for postoperative analgesia in pediatric surgery showed that the incidence of side effects as respiratory depression, itching, skin rash and vomiting was higher with morphine. Furthermore, in a study of the effect of caudal dexmedetomidine by Xiang et al ., they concluded that the supplementation of caudal bupivacaine with dexmedetomidine reduces the response to hernia sac traction in the inguinal hernia repair in paediatric surgery, besides it prolongs the duration of postoperative analgesia.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

Shamaa

Ibrahim

2014

Saudi J Anaesth

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Background:One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective α2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery.Patients and Methods:A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients (n = 25) received dexmedetomidine with bupivacaine while Group B patients (n = 25) received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway (LMA) was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded.Results:The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no significant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected.Conclusion:The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal surgery compared with caudal morphine with no side-effects on the vital signs. Postoperative side effects were seen with caudal morphine injection rather than with dexmedetomidine.

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Section: Discussionmentioning

confidence: 99%

A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

Shamaa

Ibrahim

2014

Saudi J Anaesth

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“…Morphine or fentanyl has been used most frequently in neonates and infants 22,25,30 , but the use of a wide range of opioid drugs has been reported in children 6 months and older including: alfentanil 112 , sufentanil 113–115 , buprenorphine 116 , butorphanol 117–119 , diamorphine, 120,121 , hydromorphone 122 and tramadol 103,123–127 . In surveys of UK pediatric anesthetists, 85% used opioids for epidural analgesia 77 , but variability in the agent chosen (fentanyl, morphine, or diamorphine) was noted in this and an earlier survey (21% adding fentanyl and 13% adding diamorphine to caudal anesthetic blocks) 109 .…”

Section: Clinical Choice Of a Spinal Analgesic: Efficacymentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice.

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“…Recently, in addition to the intravenous route, tramadol has been widely used for clinical pain relief through the epidural, caudal, and even intrathecal routes [6][7][8]. However, the exact mechanisms of action of tramadol at the spinal level are not completely understood.…”

Section: Introductionmentioning

confidence: 99%

The antinociceptive effect of intrathecal tramadol in rats: the role of alpha 2-adrenoceptors in the spinal cord

Chen²,

Chen³

et al. 2011

J Anesth

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A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children

Abstract: Greater epidural use of tramadol may be preferred to morphine for postoperative analgesia under these circumstances.

Cited by 35 publications

References 26 publications

A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

Neuraxial Analgesia in Neonates and Infants

The antinociceptive effect of intrathecal tramadol in rats: the role of alpha 2-adrenoceptors in the spinal cord

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