Comparison of continuous infusion and bolus administration of tramadol in postoperative children
Keywords:
tramadol, postoperative children, continuous infusion, bolus, objective pain scale (OPS)
Abstract
Objective To appraise the efficacy of tramadol therapy given bycontinuous infusion and bolus in handling child’s postoperative pain
that is mostly inadequate.
Methods This was a randomized, single-blinded clinical trial with
parallel design. The study was done in the operation room, recov-
ery room, pediatric intensive care unit, pediatric surgery, and pedi-
atric ward of Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
There were sixty patients, 1-12 year-old, with elective operation
between January and April 2002. Both groups received bolus of
2mg/kg tramadol as an initial dose. Twenty-nine subjects received
continuous infusion of 0.22 mg/kg/h tramadol in 15 minutes after-
wards. The other 31 subjects received the same boluses for every
6 hours. Before each tramadol administration, evaluation was done
by observer using objective pain scale (OPS) and evaluation sheet
that had been tested before the study. The study was done within
24 hours post surgery.
Results In the first 6 postoperative hours, mean total dose given
by continuous infusion was significantly greater than that given by
bolus (p=0.006). On the contrary, mean total dose given within 24
hours by continuous infusion was significantly less than that given
by bolus (p=0.037). All subjects showed OPS result of 36 in 0 minute.
After that, the result decreased, except in 9 subjects it was still >6
in the 15 th minute. Vomiting was the commonest side effect.
Conclusion Continuous infusion of tramadol within 24 hours can
be recommended as an analgesic in postoperative children
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preliminary review of its pharmacodynamic and phar-
macokinetic properties, and therapeutic potensial in
acute and chronic pain states. Drug 1993;46:313-40.)
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prevention of postoperative nausea and vomiting: a
quantitative systematic review of randomized, placebo-
controlled studies. Br J Anaesth 1999;83:761-71.
pain and stress. In: Hamill RJ, Rowlingson JC, editors.
Handbook of critical care pain management. New York:
McGraw-Hill; 1994. p. 39-52.
2. Desborough JP. The stress response to trauma and sur-
gery. Br J Anaesth 2000;85:109-17.
3. Sellman GL. Pain management in children. In:
Behrman RE, Kliegman RM, Nelson WE, Vaughan VC,
editors. Nelson’s textbook of pediatrics. 14 th ed. Phila-
delphia: Saunders; 1992. p. 249-52.
4. Petrack EM, Christopher NC, Kriwinsky J. Pain man-
agement in the emergency department: patterns of
analgesic utilization. Pediatrics 1997;99:711-4.
5. Boysen PG, Blau WS. Pain management and sedation
in the intensive care unit. In: Gallagher TS, editor.
Postoperative care of the critically ill patient. Baltimore:
Williams & Wilkins; 1995. p. 67-86.
6. Moore RA, McQuay HJ. Single-patient data meta-
analysis of 3453 postoperative patients: oral tramadol
versus placebo, codein and combination analgesics.
Pain 1997;69:287-94
7. Lewis KS, Han NH. Tramadol: a new centrally acting
analgesic. Am J Health-Syst Pharm 1997;54:643-52.
8. Murthy BV, Pandya KS, Booker PD, Murray A, Lintz
W, Terlinden R. Pharmacokinetics of tramadol in chil-
dren after i.v. or caudal epidural administration. Br J
Anaesth 2000;84:346-9.
9. Rud U, Fisher MV, Mewes R, Paravicini D. Postopera-
tive analgesia with tramadol. Continuous infusion ver-
sus repetitive bolus administration. Anaesthesist
1994;43:316-21.
10. Brown TCK, McKenzie IM. Anesthesia for infants and
children. In: Prys-Roberts C, Brown BR, editors. In-
ternational practice of anesthesia. Successor to gen-
eral anesthesia. Oxford : Butterworth – Heiwemann;
1996. p. 2/104/1-14.
11. Latief SA, Suryadi KA, Dachlan MR. General anes-
thesia (Anestesia Umum). In: Practical guideline
(Petunjuk praktis) of Anesthesiology (Anestesiologi).
2nd ed. Jakarta: Department of Anesthesia and Inten-
sive Therapy; 2002. p. 27-96.
12. Lee CR, McTavish D, Sorkin EM. Tramadol. A pre-
liminary review of its pharmacodynamic and phar-
macokinetic properties, and therapeutic potensial
in acute and chronic pain states. Drug 1993;46:313-
40.
13. Klarinski K, Dluholucki S, Laho S. Treatment of pain
with tramal in children above one year of age. Cs
Pediatr 1994;3:169-71.
14. Binda RE, Mestad PH. Anesthetic considerations. In:
Ashcraft KW, Holder TM, editors. Pediatric surgery.
2nd ed. Philadelphia: Saunders; 1993. p. 42-9.
15. Griessinger N, Rosch W, Schott G, Sittl R. Tramadol
infusion for pain therapy following bladder exstrophy
surgery in pediatric ward. Urologe A 1997;36:552-6.
16. Barsoum MW. Comparison of the efficacy and toler-
ability of tramadol, pethidine and nalbuphine in chil-
dren with postoperative pain. Clin Drug Invest.
1995;9:183-90.
17. Wilder-Smith CH, Bettiga A. The analgesic tramadol
has minimal effect on gastrointestinal motor function.
Br J Clin Pharmacol 1997;43:1-5.
18. Liebelt E, Levick N. Acute pain management and se-
dation in children. In: Tintinalli JE, Kelen GD,
Stapczynski JS, editors. Emergency medicine. A com-
prehensive study guide. 5th ed. New York: McGraw-
Hill; 2000. p. 890-9.
19. Houmes RJ, Voets MA, Verkaaik A, Erdmann W,
Lachmann B. Efficacy and safety tramadol versus mor-
phine for moderate and severe postoperative pain with
special regard to respiratory depression. Anesthesia and
Analgesia 1992;74:510-4.
20. Cossmann M, Wilsmann KM. Effect and side effects
of tramadol. Therapiewoche 1987;37:1-10. (Citation
from: Lee CR, McTavish D, Sorkin EM. Tramadol. A
preliminary review of its pharmacodynamic and phar-
macokinetic properties, and therapeutic potensial in
acute and chronic pain states. Drug 1993;46:313-40.)
21. Henzi I, Walder B, Tramer MR. Metoclopramide in the
prevention of postoperative nausea and vomiting: a
quantitative systematic review of randomized, placebo-
controlled studies. Br J Anaesth 1999;83:761-71.
Published
2016-09-26
How to Cite
1.
Tikoalu J-R, Darwis D, Madiyono B. Comparison of continuous infusion and bolus administration of tramadol in postoperative children. PI [Internet]. 26Sep.2016 [cited 29Apr.2024];43(5):165-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/687
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Received 2016-09-24
Accepted 2016-09-24
Published 2016-09-26
Accepted 2016-09-24
Published 2016-09-26
