A comparison of epidural tramadol and epidural morphine for postoperative analgesia

Baraka, Anis; Jabbour, Samar; Ghabash, Maroun; Nader, Antoun; Khoury, Ghattas; Sibai, Abdel Nour

doi:10.1007/bf03009627

Cited by 100 publications

(85 citation statements)

References 24 publications

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“…Baraka et al 21 reported that epidural tramadol (100 mg) provided adequate and prolonged postoperative analgesia similar to that produced by epidural morphine (4 mg) in patients undergoing major abdominal surgery without respiratory depression. In contrast, the mean PaO 2 in patients who received epidural morphine was decreased from the sixth hour postoperatively.…”

Section: Part 2: Postoperative Analgesiamentioning

confidence: 97%

“…In contrast, the mean PaO 2 in patients who received epidural morphine was decreased from the sixth hour postoperatively. 21 Previous clinical reports have also shown that parenteral morphine resulted in greater, and clinically important, respiratory depression than equi-analgesic doses of parenteral tramadol. 3, 22 Naguib et al 23 reported that the incidence of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy was 72.4% which was reduced to 34.5% after prophylactic administration of 4 mg ondansetron.…”

Section: Part 2: Postoperative Analgesiamentioning

confidence: 98%

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Perioperative antinociceptive effects of tramadol. A prospective, randomized, double-blind comparison with morphine

et al. 1998

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Purpo~: To compare the efficacy of tramadol and morphine for intra-and postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Methods: In a prospective, randomized, double-blind study 100 patients were allocated randomly into two groups. Ten minutes before induction of anaesthesia, patients in group I received 100 mg tramadol and those in group 2 Anaesthesia was induced with 5 mg.kg-thiopental and was maintained with 0 2, N20 received I0 mg morphine iv. plus isoflurane with additional doses of tramadol or morphine as decided by the attending anaesthetist. PostopeFatively, patients in group I and group 2 received tramadol and morphine, respectively, from a patient-controlled analgesia (PC.A) device. Pain, analgesic consumption, vital signs and side effects were recorded postoperatively for 24 hr. l~.~lts: Intraoperative consumption of tramadol and morphine were 137 _+ 37 and 12.2 + 3 mg, respectively. Compared with morphine, patients receiving tramadol had higher blood pressures and required greater mean ET~s o to control haemodynamic variables (P < 0.05). Postoperatively, there were no differences in observer pain score or wsual analogue pain score during the first 24 hr between groups except at 30, 45, and 90 min where patients in the tramadol group reported higher pain scores (P < 0.05). The cumulative, 24 hr PCA consumption was I 11 _+ 93 and 7.5 ---6.6 mg oftramadol and morphine, respectively. Condmiom: There was no difference between the use of tramadol and morphine to treat pain after laparoscopic cholecystectomy from 90 min after the end of surgery. Morphine was more effective than tramadol as an intraoperative analgesic.

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Section: Part 2: Postoperative Analgesiamentioning

confidence: 97%

Section: Part 2: Postoperative Analgesiamentioning

confidence: 98%

Perioperative antinociceptive effects of tramadol. A prospective, randomized, double-blind comparison with morphine

et al. 1998

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“…Tramadol may be advantageous because of a low risk of respiratory depression. 2,3 Tramadol is a weak agonist at all types of opioid receptors with some selectivity for µ receptors. Also, tramadol inhibits the reuptake of norepinephrine and serotonin, thus increasing the concentrations of these two neurotransmitters in the central nervous system.…”

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confidence: 99%

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

Gürses

Sungurtekin

Tomatir

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects.M Me et th ho od ds s: : After Ethic's Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L 3-4 interspace in 90 ASA physical status I-II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 µg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded. R Re es su ul lt ts s: : Duration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001). Pain score, respiration rate, and SpO 2 values were similar in all study groups.C Co on nc cl lu us si io on n: : We conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration. Objectif : Comparer le tramadol à la combinaison de tramadol-clonidine ou de tramadol-dropéridol en regard de leurs effets analgésiques et indésirables. Méthode : Ayant obtenu l'approbation du Comité d'éthique et le consentement éclairé des patients, nous avons réalisé l'insertion préopéra-toire d'un cathéter péridural dans l'espace intercostal L 3-4 chez 90 patients adultes d'état physique ASA I-II devant subir une intervention abdominale basse. L'anesthésie a été normalisée. Les patients ont été répartis en trois groupes de façon aléatoire. Ceux du groupe I (T) ont reçu 75 mg de tramadol, ceux du groupe II (TD), 75 mg de tramadol et 2,5 mg de dropéridol et du groupe III (TC), 75 mg de tramadol plus

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“…The relatively low lipid solubility of morphine is thought to account for its tendency for cephalad spread in the CSF. Thus, close observation is recommended for 24 hr after the last injection) [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Tramadol is a weak agonist at all types of opioid receptors with some selectivity for p receptors} ~ Also, mechanisms of action ofnon-opioid receptors may contribute to the analgesic profile. Tramadol inhibits noradrenaline uptake and stimulates serotonin release, and these are transmitters in the descending inhibitory pathways which enhance analgesia.…”

Section: Discussionmentioning

confidence: 99%

Epidural tramadol for postoperative pain after Cesarean section

Siddik-Sayyid

Aouad-Maroun

Sleiman

et al. 1999

Can J Anesth/J Can Anesth

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Purpose: To compare the post-operative analgesic effect of ~00 mg vs 200 mg epidural tramadol and saline in patients undergoing elective Cesarean section. Methods: Sixty healthy women undergoing Cesarean delivery with epidural anesthesia were randomly allocated into three groups (n = 20 in each). Patients received, at skin closure via the epidural catheter, 100 mg tramadol (Group I), 200 mg tramadol (Group II) or 10 ml saline (Control group). Pain scores and side effects were evaluated at I, 2, 4, 8, 12 and 24 hr after surgery. Mean times to the first analgesic administration, as well as the cumulative doses of analgesic requirements over 24 hr postoperatively were compared. l~sults: The mean time to first analgesic administration was longer in patients who received 100 mg tramadol

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A comparison of epidural tramadol and epidural morphine for postoperative analgesia

Cited by 100 publications

References 24 publications

Perioperative antinociceptive effects of tramadol. A prospective, randomized, double-blind comparison with morphine

Perioperative antinociceptive effects of tramadol. A prospective, randomized, double-blind comparison with morphine

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

Epidural tramadol for postoperative pain after Cesarean section

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