Comparison of patient-controlled analgesia (PCA) with tramadol or morphine

Abstract

Purpose: To compared the clinical efficacy of tramadol and morphine using a patient-controlled analgesia (PCA) delivery system. Methods: In a prospective, randomized, double blind study, we evaluated 80 adult patients scheduled for elective hip or knee arthroplasty with general inhalational anesthesia. When patients complained of pain in the recovery room, patients were randomized to receive either tramadol or morphine by titration in 30 min to achieve analgesia (VAS ~ 4). Equivalent volumes containing either 30 mg-ml -I tramadol or I mgml -I morphine were used for PCA with a lockout interval of 10 min. The patients were followed six-hourly for 48 hr for VAS, satisfaction rate, analgesic dose, and side effects. Results: Patients obtained adequate analgesia with either drug. More patients had very good satisfaction scores in the morphine group in the recovery room (43% vs 23%, P < 0.05) and at 24 hr (40% vs 20%, P < 0.05) than those in the tramadol group. More nausea was evident in the tramadol group (48% vs I I% in recovery room and 28% vs 12% in 24 hr, P < 0.05) than in the morphine group. Vomiting was also more (28% vs 5% in recovery room, 15% vs 3% in 24 hr, P < 0..05). Morphine produced more sleepiness (45% vs 23% in recovery room, P < 0.05 and 35% vs 15% in 24 hr, P < 0.05). Conclusion: Tramadol PCA can provide effective analgesia following major orthopedic surgery provided sufficiently high doses are given for loading and by patient demand. However, the incidence of nausea/vomiting is also higher causing decreased satisfaction.Objectif : Comparer I'efficacit~ clinique du tramadol et de la morphine en utilisant un syst~me d'analg&ie contr61~e par le patient (ACP). M~.thode : Lors d'une &ude prospective, randomis~e et en double aveugle, nous avons ~valu~ 80 adultes dont rarthroplastie de la hanche ou du genou avait ~t~ pr~vue avec une anesth&ie g~n&ale d'inhalation./~ la salle de r~veil, les patients r~partis au hasard ont re,u, quand ils ~prouvaient de ta douleur, du tramadol ou de la morphine selon un dosage permettant d'atteindre I'analg&ie (EVA ~ 4) en 30 min. Des volumes ~quivalents contenant 30 mg.ml -~ de tramadol ou I mg-ml -~ de morphine ont ~t~ utilis& pour I'ACP, qui comprenait une p&iode r~ffac-taire de 10 min. Les patients ont ~t~ revus ~ toutes les six heures pendant 48 h pour I'enregistrement des scores de I'EVA, de la satisfaction, de la dose d'analg&ique et des effets secondaires. l~-'ultats : Les patients ont obtenu une analg&ie suffisante avec I'un ou ['autre m~dicament. Un plus grand nombre de patients a &~ tr~s satisfait darts le groupe ayant re~u de la morphine ~ la salle de r~veil (43 % vs 23 %, P < 0,05) et ~ 24 h (40 % vs 20 %, P < 0,05) que ceux du groupe ayant re~u le tramadol. II y a eu davantage de naus~es dans le groupe du tramadol (48 % vs I 1% dans la salle de r~veil et 28 % vs 12 % ~ pendant les 24 premi&es heures, P < 0,05) que dans le groupe de la morphine. Les vomissements ont ~t~ ~galement plus frequents (28 % vs 5 % en salle de r~veil, 15 % vs 3 % pendant les 24 premi&es...

Metoclopramide decreases emesis but increases sedation in tramadol patient-controlled analgesia

“…Our previous study 12 indicated an incidence of nausea of 48% in patients receiving PCA with tramadol alone. We estimated an incidence of nausea of less than 15% in patients receiving PCA with tramadol plus metoclopramide.…”

“…Our previous study showed that if a loading dose of tramadol PCA is given in the PACU to achieve analgesia, almost half of the patients will complain of nausea. 12 Nausea/vomiting appears to be dose and administration rate related and can be reduced by loading the drug before the end of surgery. 13 We have shown that adding metoclopramide to tramadol PCA will further decrease nausea/vomiting.…”

Tramadol 2.5 mg·kg−1 appears to be the optimal intraoperative loading dose before patient-controlled analgesia

“…4,7 We reported previously that by administering a 5 mg·kg -1 tramadol loading dose during surgery, the nausea/vomiting associated with tramadol PCA in the postanesthesia care unit (PACU) can be significantly reduced. 8 This is a follow-up study to determine the optimal intraoperative loading dose when tramadol PCA is used for postoperative pain control.…”

Comparison of Postoperative Analgesic Effects of Low Frequency TENS and Conventional TENS Used After Abdominal Hysterectomy

“…Aşırı sedasyonun önlenmesinde en etkili yollarından biri tüketilen opiyoid dozunun azaltılmasıdır. (22) Bu çalışmada, iki grupta da yeterli sedasyon sağlanmış, aşırı sedasyon hiçbir hastada gözlenme-miştir. Gruplar arasında yalnızca 18. saatte olan istatistiksel farklılık klinik olarak anlamlı kabul edilmemiştir.…”